Use of oral anticoagulation for patients who undergo invasive procedures

The performance of invasive procedures in patients undergoing oral anticoagulation represents a risk. Without conclusive data on this issue, the recommendations on managing oral anticoagulation are generally weak, and its management is controversial and heterogeneous. We conducted a review of the evidence on the elective periprocedural management of oral anticoagulation following the publication of the 9th edition of the guidelines of the American College of Chest Physicians. Except for cases of procedures with minimal haemorrhagic risk, the use of oral anticoagulants is suspended with sufficient time so that it can be performed without a significant anticoagulant effect, which will depend on the half-life of the drug. For direct oral anticoagulants, the half-life is determined by the renal function. Recent studies have shown that the use of bridge therapy with heparin in patients who temporarily suspended the use of oral anticoagulation provided no benefits and increased the bleeding. However, there is no conclusive evidence against its use in patients with a high thromboembolic risk.