The BRIDGE trial: What the hospitalist should know.
Atrial fibrillation patients often require warfarin interruption for an invasive procedure or surgery. Heparin bridging therapy has been frequently used during warfarin interruption under the premise of providing a theoretical mitigation against thromboembolism that overweighs expected higher rates of bleeding. Up until recently, little definite clinical evidence was available to guide the hospitalist on optimal perioperative anticoagulant management. The landmark BRIDGE (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation) trial provided high-quality evidence that a simple interruption of warfarin in the average atrial fibrillation patient undergoing an elective procedure or surgery is noninferior to bridging therapy for efficacy and superior to bridging therapy in preventing major bleeding. To guide the hospitalist, we propose a treatment algorithm based on these recent data. We review the literature that led to the trial and highlight its practice-changing implications as a proof of concept that calls to question the premise of heparin bridging therapy beyond the atrial fibrillation population. Journal of Hospital Medicine 2016;11:652-657. © 2016 Society of Hospital Medicine.
Department of Medicine, Staten Island University Hospital-Northwell Health, Staten Island, New York. bnazha@northwell.edu.
Bassel
B
Nazha
Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra-Northwell Health School of Medicine, Northwell Health at Lenox Hill Hospital, New York, New York.
Alex C
AC
Spyropoulos
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D020445:Hospitalists; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin