Perioperative bridging anticoagulation for atrial fibrillation-the first randomised controlled trial.
Patients who have atrial fibrillation (AF) have increased thromboembolic risk. This risk is mitigated through use of anticoagulants, traditionally with vitamin K antagonists such as warfarin, and more recently with drugs such as Xa and thrombin inhibitors. Since anticoagulants increase the risk of bleeding, uncertainty exists regarding their use in the perioperative period. The risk of thromboembolism for each patient must be balanced against risk of bleeding; anticoagulation medication may be continued, replaced with a short-acting alternative or withheld entirely. Until recently, evidence on best management relied on expert opinion and observational studies. The recent publication of a randomised, double-blind, placebo-controlled trial (BRIDGE) has added important information to the knowledge base.


BACKGROUND
BRIDGE ClinicalTrials.gov, NCT00786474.
Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK.
James Matthew
JM
Wight
Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Wythenshawe, UK.
Malachy Oliver
MO
Columb
Anticoagulation; Atrial fibrillation; Bleeding; Bridging; Low molecular weight heparin; Thromboembolism; Warfarin