Suspensión de la anticoagulación oral en pacientes con fibrilación auricular ante un procedimiento invasivo. ¿Deben recibir un puenteo con anticoagulación parenteral durante su realización?

Abstract

Many patients with atrial fibrillation are anticoagulated for long periods. During this time they may be subjected to invasive procedures. From a clinical vignette, a physician discusses the impact of using (or not) low molecular weight heparin as a pharmacological bridge at the time of suspending oral anticoagulation. After conducting a bibliographic search, a no inferiority randomized clinical trial showed that in patients with atrial fibrillation with intermediate to low thromboembolic risk (CHADS2) requiring a temporary interruption of warfarin therapy for an elective invasive procedure, the strategy of withholding low molecular weight heparin bridging was not inferior (or less effective) for the prevention of arterial thromboembolism than its use, also decreasing the risk of major bleeding.