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The long-term use of oral anticoagulants is common among certain high-risk patient populations for the prevention of thromboembolic events such as stroke, pulmonary embolism (PE), and other systemic events. According to Garwood et al. (2017) it is estimated that 15-20% of chronically anticoagulated patients will undergo a surgery or procedure that will require anticoagulation interruption annually. During this interruption period, “bridging” anticoagulant therapy is often utilized with unfractionated heparin or low-molecular weight heparin to ensure adequate anticoagulation is achieved (Ayoub et al., 2016). However, there has been an ongoing debate whether or not the benefits of perioperative anticoagulant bridging therapy outweigh its risks.
This literature review focuses on whether or not forgoing anticoagulant bridging therapy increases the risk of postoperative thromboembolic events. It also focuses on the whether or not initiating bridging therapy places patients at a higher risk for postoperative bleeding. Finally, it focusses on the current recommendations and whether or not utilization of individualized risk assessment tools increases efficacy and safety in regards to determining appropriate bridging therapy.
The results of this literature review conclude that in low risk patients there is sufficient evidence to support the statement that non-bridging therapy is equally as efficacious to bridging therapy in the prevention of peri/postoperative thromboembolic events. There is also evidence to support the statement that traditional bridging therapy may place low risk patients at an increased risk for peri/postoperative bleeding events. Finally, there appears to be sufficient support to encourage the use of individualized risk assessment tools to help guide clinicians in their decisions to use or forgo anticoagulant bridging therapy.
perioperative; anticoagulant; interruption; adverse effects; bridging therapy; patients; thromboembolism; complications; hemorrhage; bleeding event; time factors; risk assessment
Buchholz, Jordan, "A Bridge Too Far? Risks and Benefits of Perioperative Bridging Therapy" (2018). Physician Assistant Scholarly Project Posters. 8.