POEMs

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.

Clinical Question

Does bridging anticoagulation during a procedure improve or worsen patient-oriented outcomes?

Bottom Line

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)

Synopsis

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.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

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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