title: [Perioperative heparin bridging is rarely indicated].
abstract: Meta-analyses of cohort studies and a recent randomized, placebo-controlled study have shown that perioperative bridging of warfarin therapy with therapeutic doses of heparin results in a multi-fold increase in major bleeding but no reduction in the incidence of thromboembolism. It is time to reconsider heparin bridging: When is heparin bridging superfluous? When is prophylactic dosage indicated? And when is it safe to use therapeutic dosing?
authors.affiliation: jdn@dadlnet.dk.
authors.forename: Jørn Dalsgaard
authors.initials: JD
authors.lastname: Nielsen
authors.forename: Anna-Marie Bloch
authors.initials: AM
authors.lastname: Münster
authors.forename: Steen Elkjær
authors.initials: SE
authors.lastname: Husted
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019990:Perioperative Care; D013923:Thromboembolism / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D014859:Warfarin; D006493:Heparin