![]() ![]() Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, Saad WA. recent studies, including the BRIDGE trial and possibly the awaited PERIOP 2 trial have cast doubt on the efficacy of bridging anticoagulation.recent coronary artery stenting – seek cardiology opinion.VTE within 3 months or severe thrombophilia.high risk atrial fibrilation – CHADS2 5-6.the patients who generally require bridging are:.bridging is usually achieved with a therapeutic dosing of LMWH or UFH but may be done at prophylactic doses or in-between depending on risk. ![]() patients on NOACs generally do not require bridging as they have a rapid onset of anticoagulation.It is generally commenced once the INR is below the therapeutic level (2-3 days after ceasing) and stopped once the INR returns to a therapeutic level bridging therapy is sometimes warranted in patients taking warfarin, due to slow reversal and anticoagulation.the aim of bridging is to minimize the time someone is not anticoagulated periprocedurally.when to withhold: moderate and high risk procedures.this is usually administered subcutaneously as a prophylactic anticoagulant (5000U every 8-12 hour).when to restart: 6-48 hours depending on bleeding risk.rapid reversal of heparin is achievable with IV protamine.the reversal can be measured with the patients aPTT.when to withhold: low, moderate and high-risk procedures.Moderate to high-risk procedures require withholding for 24 hours and recommencing at 24-48 hours therapeutic dose: Low-risk procedures require 12-24 hours withholding and restarting at 6 hours.Moderate to high-risk procedures require withholding from 12-24 hours and 24 hours until the LMWH is restarted prophylactic dose: Low-risk procedures do not require ceasing.The aPTT is not a reliable measure if its effect the activity can be measured using the anti-factor Xa assay.administered subcutaneously at either prophylactic or therapeutic doses.for low bleeding risk withhold for 3-5 days aim INR /= 5 days.warfarin is a vitamin K antagonist that has reduced in use since the addition of DOACs, but is still used in patients with prosthetic mechanical valves, venous thromboembolic disease and atrial fibrillation.It is always useful seek cardiology opinion when considering temporary cessation of antiplatelet therapy in these patients. 6-12 months following the placement of a drug eluding stent. ![]()
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