Bridge Therapy: To Bridge, or not to Bridge, that is the Question?

Abstract

Patients undergoing oral anticoagulation treatment with vitamin K antagonist (VKA) therapy are at a high risk of bleeding when undergoing an oral surgical procedure. Bridging therapy with parenteral heparin, aims to protect these patients against thromboembolism during temporary periprocedural interruption of VKA therapy. Whether or not to interrupt VKA therapy and initiate bridging therapy is a difficult decision that is based upon both the patient's and the procedure's risks. The management of anticoagulation in patients undergoing surgical procedures is challenging because Interruption of anticoagulation temporarily increases thromboembolic risk and potentially fatal, while, continuing anticoagulation increases the risk of bleeding associated with surgical procedures; both of these outcomes adversely affect mortality.