Bridging Anticoagulation: When Is It Needed Before Surgery?
Bridging Anticoagulation: When Is It Needed Before Surgery?
The Big Picture
Bridging anticoagulation involves using short-acting blood thinners before surgery in patients who normally take long-acting ones. But is this extra step always necessary?
Contents
- What Is Bridging?
- Who Needs Bridging?
- Risks vs. Benefits
- Alternatives to Bridging
What Is Bridging?
Bridging uses injectable blood thinners like heparin to prevent blood clots when a patient stops their usual oral medication before surgery. It's like a temporary stand-in to keep blood from clotting. The goal is to minimize time without protection from blood clots.
Who Needs Bridging?
Most patients don't need bridging therapy. It's mainly used for high-risk cases, such as those with mechanical heart valves or very recent blood clots or strokes. Your doctor will assess your individual risk factors to decide if bridging is necessary.
Risks vs. Benefits
While bridging can prevent blood clots in high-risk patients, it also increases bleeding risk during surgery. For most patients, the risks outweigh the benefits. Studies show bridging doesn't reduce clot risk for most people but does raise bleeding risk.
Alternatives to Bridging
Instead of bridging, many patients can simply stop their blood thinner for a few days before surgery. Newer blood thinners like apixaban or rivaroxaban can often be stopped just 1-2 days before surgery without bridging. This approach is simpler and often safer for most patients.
FAQs
Do I need bridging if I take warfarin?
Most warfarin patients don't need bridging before surgery.
What if I recently had a blood clot?
Recent clots may require bridging or postponing elective surgery.
Is bridging used after surgery too?
Sometimes, until your usual medication becomes effective again.
Does bridging increase my hospital stay?
It can, due to extra monitoring and potential complications.
What are signs of problems during bridging?
Watch for unusual bruising, bleeding, or clot symptoms.
Key Takeaways
Bridging therapy is necessary for some high-risk patients, but most can safely stop blood thinners briefly without it.
Additional References
- Douketis JD et al. N Engl J Med. 2015;373(9):823-833.
- Siegal D et al. Circulation. 2012;126(13):1630-1639.
- Kovacs MJ et al. BMJ. 2021;373:n1205.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic.