title: A Call to Reduce the Use of Bridging Anticoagulation.
abstract: Because of the recent publication of several important studies, there has been a major change in how we think about perioperative management of anticoagulation. Because of these changes, existing consensus guidelines are suddenly out of date and can no longer be used as is, particularly the 2012 American College of Chest Physicians Antithrombotic Guidelines, version 9. We estimate that well over 90% of patients receiving warfarin therapy should not receive bridging anticoagulation during periprocedural interruptions of therapy, except under unusual circumstances and with appropriate justification. Accumulating evidence also suggests that bridging is not indicated among patients receiving direct-acting oral anticoagulant therapy. The large number of patients potentially affected represents an important safety concern and requires an immediate change in practice.
authors.affiliation: From the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, MA (A.J.R.); Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, MA (A.J.R.); Department of Pharmacy, VA Salt Lake City Healthcare System, UT (A.L.A.); Department of Medicine, San Francisco VA Medical Center, CA (T.M.); and Department of Medicine, University of California San Francisco School of Medicine (T.M.). adamrose@bu.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
authors.affiliation: From the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, MA (A.J.R.); Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, MA (A.J.R.); Department of Pharmacy, VA Salt Lake City Healthcare System, UT (A.L.A.); Department of Medicine, San Francisco VA Medical Center, CA (T.M.); and Department of Medicine, University of California San Francisco School of Medicine (T.M.).
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Allen
authors.affiliation: From the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, MA (A.J.R.); Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, MA (A.J.R.); Department of Pharmacy, VA Salt Lake City Healthcare System, UT (A.L.A.); Department of Medicine, San Francisco VA Medical Center, CA (T.M.); and Department of Medicine, University of California San Francisco School of Medicine (T.M.).
authors.forename: Tracy
authors.initials: T
authors.lastname: Minichello
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019990:Perioperative Care; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin
keywords: anticoagulants; evidence-based medicine; heparin, low-molecular weight; humans; perioperative care; practice guideline; warfarin