Abstract
Patients who have atrial fibrillation (AF) have increased thromboembolic risk. This risk is mitigated through use of anticoagulants, traditionally with vitamin K antagonists such as warfarin, and more recently with drugs such as Xa and thrombin inhibitors. Since anticoagulants increase the risk of bleeding, uncertainty exists regarding their use in the perioperative period. The risk of thromboembolism for each patient must be balanced against risk of bleeding; anticoagulation medication may be continued, replaced with a short-acting alternative or withheld entirely. Until recently, evidence on best management relied on expert opinion and observational studies. The recent publication of a randomised, double-blind, placebo-controlled trial (BRIDGE) has added important information to the knowledge base.Trial registrationBRIDGE ClinicalTrials.gov, NCT00786474
Highlights
New researchDouketis et al present the first randomised controlled trial of the benefits and risks of bridging anticoagulation (Douketis et al 2015)
The primary efficacy outcome was the incidence of arterial thromboembolism (ATE) at 30 days, and the primary safety outcome was major bleeding at 30 days
Many surgical procedures associated with high rates of ATE were not represented at all, including carotid endarterectomy and major cancer surgery
Summary
Approximately 10 % of warfarinised patients with AF present for surgery or invasive procedure (Douketis et al 2012; Healey et al 2012). Warfarin was restarted on the day of or the day after surgery. Dalteparin or placebo was restarted at 12–24 or 48–72 h after surgery for low or high bleeding risk procedures respectively and was continued until the INR was 2.0 or higher. The primary efficacy outcome was the incidence of arterial thromboembolism (ATE) at 30 days (stroke, systemic embolism, transient ischaemic attack), and the primary safety outcome was major bleeding at 30 days. The authors performed a one-sided ‘non-inferiority’ test within a margin of 1 % of placebo to dalteparin comparing ATE rates. A two-sided ‘superiority’ test was performed to compare major haemorrhage rates. The study had 90 % power for the two primary end points
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
