Am Fam Physician. 2016 Jan 15;93(2):130.
Does bridging anticoagulation during invasive procedures improve outcomes in patients with atrial fibrillation who take warfarin (Coumadin)?
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.
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