Perioperative Bridging Anticoagulation Unhelpful for Invasive Procedures


Am Fam Physician. 2016 Jan 15;93(2):130.

Clinical Question

Does bridging anticoagulation during invasive procedures improve outcomes in patients with atrial fibrillation who take warfarin (Coumadin)?

Bottom Line

Bridging anticoagulation worsens outcomes for patients with atrial fibrillation who undergo an elective invasive procedure, resulting in more episodes of major bleeding and no difference in the rate of stroke or venous thromboembolism. Most of the patients in the study had a CHADS2 score of 1 (23%), 2 (40%), 3 (24%), or 4 (10%). The patients were largely undergoing minor surgical procedures with low bleeding risk, and patients at very high risk of thromboembolism or stroke were not represented in this study. (Level of Evidence = 1b)


The evidence for bridging anticoagulation is looking increasingly questionable, with a recent registry-based study finding worse outcomes with bridging (http://www.essentialevidenceplus.com/content/poem/170602; login required). This study provides the best evidence to date.

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 Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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Jan 15, 2017

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