The intent of bridging is to minimize the time the patient is not anticoagulated, thereby minimizing the risk for perioperative thromboembolism.The newer direct oral anticoagulants (eg, direct thrombin inhibitor dabigatran, factor Xa inhibitors rivaroxaban, apixaban, edoxaban ) have shorter half-lives, making them easier to discontinue and resume rapidly, but the direct factor Xa inhibitors lack a specific antidote, which raises concerns about treatment of bleeding and management of patients who require an urgent procedure.Patients who require surgery within the first three months following an episode of VTE are likely to benefit from delaying elective surgery, even if the delay is only for a few weeks.Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding.Objective To determine the efficacy and safety of enoxaparin compared with unfractionated heparin during percutaneous coronary intervention.The risk of bleeding is dominated by the type of surgery or invasive procedure.A normal or near-normal anti-factor Xa activity level may be used in selected patients to evaluate whether edoxaban has been adequately cleared from the circulation prior to surgery (eg, patients at high risk of surgical bleeding) ( table 7 ).Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy.
Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures.
Perioperative bridging anticoagulation in patients with atrial fibrillation.
We reserve bridging anticoagulation for selected individuals who are at very high risk for postoperative thromboembolism and require extended interruption of dabigatran.Thus, for high bleeding risk procedures, the patient will skip two doses of rivaroxaban, and not receive any doses on surgical days minus 2, minus 1, or the day of surgery.
Management of anticoagulation in patients with prosthetic heart valves undergoing oral and maxillofacial operations.Bridging evidence-based practice and practice-based evidence in periprocedural anticoagulation.Perioperative Management of Dabigatran: A Prospective Cohort Study.Patients were excluded from the trial if they had a mechanical heart valve, or a recent (within previous 12 weeks) stroke, embolism, or transient ischemic attack.
Enoxaparin (Lovenox) - Home DVT Treatment Program Model Guidelines for Implementation.If the patient bleeds from the procedure, their anticoagulant may need to be discontinued for a longer period, resulting in a longer period of increased thromboembolic risk.Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial.Dabigatran etexilate--a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity.
For bridging anticoagulation during temporary interruption of warfarin therapy in patients.The perioperative risk of venous thromboembolism (VTE) is greatest in individuals with an event (eg, deep vein thrombosis, pulmonary embolus) within the prior three months and those with a history of VTE associated with a high-risk inherited thrombophilia ( table 1 ).How I treat anticoagulated patients undergoing an elective procedure or surgery.We take into account these risks, along with specific features of the anticoagulant the patient is taking.
Interactions with drugs that inhibit only one of these enzymes do not seem to alter rivaroxaban anticoagulant effect.Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery.We often delay apixaban for two to three days after high bleeding risk procedures, and if needed use prophylactic dose LMW heparin for this period.
Temporary discontinuation of warfarin therapy: changes in the international normalized ratio.We often delay resumption of dabigatran for two to three days after high bleeding risk procedures and, if needed, administer a lower dabigatran dose for the initial two to three postoperative days (eg, 110 mg once daily) or use prophylactic dose LMW heparin for this period.