Periprocedural Anticoagulant Bridging

What the result means

A direct oral anticoagulant

Interrupted on the bleeding risk of the procedure and on renal function, and never bridged. The short half-life is the bridge, and no INR times it.

Warfarin, low or moderate risk

Interrupted, and not bridged. The BRIDGE trial showed bridging increases major bleeding without reducing thromboembolism in most patients.

Warfarin, high thrombotic risk

The small group in which bridging is considered: a mechanical mitral valve, a stroke or venous thromboembolism within 3 months, or an equivalent. Still a judgment.

Minimal bleeding risk

Interruption may not be needed at all. Many dental, dermatologic, ophthalmic and endoscopic procedures are done on anticoagulation.

The default

Not to bridge. Bridging was routine for years and the evidence reversed it, so the question is whether this patient is one of the few exceptions.

Resumption

Its own decision, timed on hemostasis rather than the calendar. A therapeutic-dose resumption after a high-bleeding-risk procedure is usually delayed further.