Anticoagulants: bridging therapy for surgery
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Anticoagulants: bridging therapy for surgery. Mechanical heart valves, Atrial fibrillation with CHADS2 score >4. Fully referenced neurology checklist.
Indications
- Mechanical heart valves
- Atrial fibrillation with CHADS2 score >4
- Atrial fibrillation with a history of recent stroke or TIA within 3 months
- Atrial fibrillation associated with rheumatic valve disease
- Venous thromboembolism within 3 months of event
- Venous thromboembolism with severe thrombophilia
- Venous thromboembolism with Protein C, S or anti-thrombin deficiency
- Venous thromboembolism with the antiphospholipid antibody (APL) syndrome
- Venous thromboembolism with multiple thrombophilias
Bridging protocol
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References
- Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 2012; 120:2954-2962.
- Douketis JD. Perioperative management of patients who are receiving warfarin therapy: an evidence-based and practical approach. Blood 2011; 117:5044-5049.
- Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e326S-e350S.
- BRIDGE Study Investigators. Bridging anticoagulation: is it needed when warfarin is interrupted around the time of a surgery or procedure? Circulation 2012; 125:e496-e498.
