title: [Not Available].
abstract: The management of anticoagulation in patients undergoing invasive procedures is a complex clinical problem. Interrupting anticoagulation for a procedure increases the risk of thromboembolism. On the other hand, bridging anticoagulation with an alternative, short-acting anticoagulans increases the risk for peri-operative bleeding. A recent randomized controlled trial (the BRIDGE trial) shows that in patients with atrial fibrillation who had anticoagulant treatment interrupted for an elective invasive procedure, a strategy of forgoing bridging anticoagulation decreased the risk of major bleeding and was non-inferior to peri-operative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism. However, the study deserves comment. First, most of the patients were classified at low risk for thromboembolism, with a mean CHADS2-score of 2.3. Second, the majority of the procedures were low bleeding risk procedures. Whether bridging anticoagulation is helpful for patients with moderate to high-risk for thromboembolism undergoing high bleeding risk procedures remains unanswered.
authors.affiliation: Tergooi, afd. Intensive Care, Hilversum.
authors.forename: Roel
authors.initials: R
authors.lastname: Vink
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight