Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!

I am interrupting my current obsession with Top 5 lists  to bring you this important announcement: Peri-operative anti-coagulation, (also known as bridging anti-coagulation) is done! Is it time to stick a fork in it?

Right now you’re probably wondering, what the heck I’m talking about, and why you should consider it important. Currently hundreds of thousands of people throughout the country are on the oral blood thinner coumadin (also known as warfarin) to prevent a blood clot. For those who are on it long term, having a procedure can be problematic, as stopping the drug can increase the risk of blood clots, while continuation of the drug increases the risk of bleeding with surgery. Thus many patients undergo a process known as “bridging” wherein the coumadin is stopped  several days before the surgery, and a short acting injectable blood thinner is substituted so that the blood thinning effect of coumadin has time to wane before the surgery. This practice has been perpetuated without very clear evidence that it decreases the risk of blood clots or bleeding, and without much certainty about which people on coumadin need to be “bridged”. Recently, researchers sought to shed some light on this question by pooling together data from several smaller studies looking at patients who underwent bridging  to determine what the various risks and benefits of bridging might be.  The study  “Periprocedural Heparin Bridging in Patients Receiving Vitamin K Antagonists” was published  in the Journal Circulation and has received much attention, as it should have as it was co-authored by my former mentor (shout out Dr. Kaatz!) but also since it is the first large scale study of its kind. Continue reading “Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!”