Annals for Hospitalists Inpatient Notes - How I Changed My Practice—Perioperative Bridging Anticoagulation
Authors: Paul J. Grant
Journal: Annals of Internal Medicine (2018)

Web Exclusives20 November 2018Annals for Hospitalists Inpatient Notes - How I Changed My Practice—Perioperative Bridging AnticoagulationPaul J. Grant, MDPaul J. Grant, MDUniversity of Michigan Medical School, Ann Arbor, Michigan (P.J.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2734 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Perioperative management of patients receiving systemic anticoagulation for atrial fibrillation or flutter can be challenging. For most of my career, I adhered to a “conservative” strategy, bridging most patients with low-molecular-weight heparin while warfarin therapy was temporarily stopped. I now believe that perioperative bridging anticoagulation therapy should only rarely be implemented during temporary cessation of warfarin.The EvidenceUntil recently, published evidence about the risks and benefits of perioperative bridging anticoagulation therapy has been limited. Although the concept seems straightforward (it decreases the risk for arterial thromboembolism but also increases the risk for bleeding), the magnitude of the risks and ...References1. Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W, Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation. 2012;126:1630-9. [PMID: 22912386] CrossrefMedlineGoogle Scholar2. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al; BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823-33. [PMID: 26095867] doi:10.1056/NEJMoa1501035 CrossrefMedlineGoogle Scholar3. Rose AJ, Allen AL, Minichello T. A call to reduce the use of bridging anticoagulation. Circ Cardiovasc Qual Outcomes. 2016;9:64-7. [PMID: 26715651] doi:10.1161/CIRCOUTCOMES.115.002430 CrossrefMedlineGoogle Scholar4. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e326S-e350S. [PMID: 22315266] doi:10.1378/chest.11-2298 CrossrefMedlineGoogle Scholar5. Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Ortel TL, Saxonhouse SJ, et al. 2017 ACC expert consensus Decision Pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology clinical expert consensus document task force. J Am Coll Cardiol. 2017;69:871-98. [PMID: 28081965] doi:10.1016/j.jacc.2016.11.024 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan Medical School, Ann Arbor, Michigan (P.J.G.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2734.Corresponding Author: Paul J. Grant, MD, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected]umich.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 20 November 2018 David H. Wesorick and Vineet Chopra Perioperative Bridging Anticoagulation Lubina Arjyal Metrics Cited byPerioperative Bridging AnticoagulationLubina Arjyal, MD 20 November 2018Volume 169, Issue 10Page: HO2-HO3KeywordsAtrial fibrillationDisclosureHemorrhageLow molecular weight heparinOdds ratioStrokeSurgeryThromboembolismTransient ischemic attacksTreatment guidelines ePublished: 20 November 2018 Issue Published: 20 November 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...