Bridging anticoagulation in patients receiving vitaminKantagonists : Current status

Abstract

Approximately 30% of patients receiving oral anticoagulation using vitaminK antagonists (VKA) require surgery within 2years. In this context, aclinical decision on the need and the mode of aperi-interventional bridging with heparin is needed. While afew years ago, bridging was almost considered astandard of care, recent study results triggered adiscussion on which patients will need bridging at all. Revisiting the currently available recommendations and study results the conclusion can be drawn that the indications for bridging with heparin must nowadays be taken more narrowly and considering the individual patient risk of bleeding and thromboembolism. Bridging with heparin is only needed in patients with a very high risk of thromboembolism. This overview aims to give guidance for arisk-adapted peri-interventional approach to management of patients with aneed for long-term anticoagulation using VKA.