Bridging Anticoagulation in Patients with Atrial Fibrillation Associated with More Cardiovascular Events and Bleeding
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Am Fam Physician. 2015 Sep 1;92(5):398.
Does bridging anticoagulation during a procedure improve or worsen patient-oriented outcomes?
This study provides more evidence that bridging in patients with nonvalvular atrial fibrillation does not improve outcomes, and is actually associated with a higher risk of bleeding complications and cardiovascular events. (Level of Evidence = 2b)
Bridging anticoagulation substitutes an anticoagulant that is slower to reverse (such as warfarin [Coumadin]) with one that is easily reversed in case of emergency (heparin) in patients undergoing a surgical procedure. But does all that hassle really improve outcomes? A recent randomized trial in patients undergoing placement of a pacemaker found that bridging anticoagulation led to worse outcomes (http://www.essentialevidenceplus.com/content
POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.
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This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.
A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.
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