Related Experiment Video
Updated: Mar 15, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
A Bridge to Nowhere? Benefits and Risks for Periprocedural Anticoagulation in Atrial Fibrillation
Arun Krishnamoorthy1, Thomas Ortel2,3
1Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Insights
For patients with atrial fibrillation (AF) undergoing procedures, bridging anticoagulation increases bleeding risk without reducing stroke risk. Current evidence suggests avoiding bridging for most elective procedures.
Area of Science:
- Cardiology
- Thrombosis and Hemostasis
- Clinical Trials
Background:
- Oral anticoagulation is crucial for preventing stroke in atrial fibrillation (AF) patients.
- Interruption of anticoagulation for procedures poses a thromboembolic risk.
- Bridging anticoagulation is a common but potentially high-risk practice.
Purpose of the Study:
- To evaluate the efficacy and safety of bridging anticoagulation in AF patients undergoing procedures.
- To inform clinical decision-making regarding periprocedural anticoagulation strategies.
Main Methods:
- Review of recent data, including the BRIDGE trial.
- Analysis of secondary outcomes from phase 3 randomized clinical trials of direct-acting oral anticoagulants (DOACs).
Main Results:
- Bridging anticoagulation is associated with increased periprocedural bleeding.
- No significant reduction in thromboembolic events was observed with bridging.
- Current evidence favors avoiding bridging in most AF patients with low-to-moderate risk.
Conclusions:
- Bridging anticoagulation is not recommended for elective procedures in most AF patients.
- The risks of bleeding outweigh the benefits of bridging in this population.
- Updated trial data support revised periprocedural anticoagulation strategies.
Abstract:
In patients with atrial fibrillation (AF), oral anticoagulation is used to prevent stroke and systemic embolism. In a common clinical scenario, AF patients frequently undergo invasive procedures requiring temporary interruption of oral anticoagulation, thereby potentially exposing such patients to increased risk of thromboembolism. Bridging anticoagulation has been used clinically to mitigate this perceived thromboembolic risk, though this practice may also increase risk of periprocedural bleeding. High-quality data has not previously existed to inform decision-making in this clinical situation of bridging anticoagulation. We discuss recent results from the BRIDGE trial and secondary analyses from recent phase 3 randomized clinical trials of direct-acting oral anticoagulant (DOAC) use in non-valvular AF, that inform periprocedural anticoagulation with bridging strategies in AF patients. Updated data from these current trials favor against a strategy of bridging anticoagulation for elective procedures in the majority of AF patients, low or moderate in thromboembolic risk. Bridging anticoagulation is associated with an increased risk of bleeding and no decreased risk of thromboembolism.
