The current status of bridging anticoagulation.
For patients prescribed chronic vitamin K antagonist therapy requiring a surgical or invasive procedure, the question of whether or not to bridge and how to bridge is commonly encountered in clinical practice. Bridging anticoagulation has evolved over the years and the evidence base for current practice is deficient in many areas. Clinical trials currently being completed with conventional anticoagulants should help strengthen the evidence base for future practice. The availability of novel oral anticoagulants is a welcome addition, though their optimal management peri-procedure is yet to be determined. Prospective multi-centre controlled studies that can provide the evidence base for novel oral anticoagulant peri-procedural management are required.
Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, UK; Institute of Pharmaceutical Science, King's College London, London, UK.
Jignesh P
JP
Patel
Roopen
R
Arya
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D013923:Thromboembolism / Q000209:etiology; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K
anticoagulation; bridging; low molecular weight heparin; surgical procedures; vitamin K antagonist therapy