[Perioperative heparin bridging is rarely indicated]

Area of Science:

• Cardiology
• Pharmacology
• Surgical Medicine

Background:

• Vitamin K antagonists (VKAs) require careful management around surgical procedures.
• Heparin bridging is a common practice to mitigate anticoagulation interruption risks.
• Direct oral anticoagulants (DOACs) offer an alternative with different pharmacokinetic profiles.

Purpose of the Study:

• To review the evidence on perioperative heparin bridging in patients on VKAs.
• To evaluate the efficacy and safety of heparin bridging in reducing postoperative thromboembolism.
• To assess the relevance of heparin bridging for patients on DOACs.

Main Methods:

• Systematic review of existing studies on perioperative anticoagulation.
• Analysis of bleeding incidence and thromboembolic events.
• Comparison of outcomes between heparin bridging and no bridging strategies.

Main Results:

• Perioperative heparin bridging in VKA patients significantly increases bleeding complications.
• No substantial evidence supports heparin bridging for reducing postoperative thromboembolism.
• Heparin bridging is not indicated for patients on DOACs due to their rapid action.

Conclusions:

• Heparin bridging for VKA patients around surgery is associated with higher bleeding risks and lacks proven thromboembolic benefits.
• Prophylactic heparin dosages are recommended post-major surgery.
• The distinct pharmacokinetics of DOACs render heparin bridging irrelevant in this patient group.