Abstract
Patients with atrial fibrillation receiving long-term oral anticoagulation for stroke prevention may one day undergo an invasive procedure or surgery. Two fundamental decisions must then be made preprocedurally: (1) whether to interrupt anticoagulation preprocedurally, and if so decided, then (2) whether to initiate parenteral heparin bridging anticoagulation. These two decisions must take into account the thromboembolic risk during interruption of anticoagulation and the periprocedural bleeding risk with continued anticoagulant administration. These decisions are most challenging for those patients at high thromboembolic risk off anticoagulation who are to undergo a high bleeding risk procedure. This chapter will (1) review potential means to assess both periprocedural thromboembolic and bleeding risks and (2) provide potential strategies to mitigate both.
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