Atrial Fibrillation: To Bridge or Not to Bridge Preoperatively

Surgical procedures in patients who receive chronic anticoagulation often require cessation of warfarin therapy. Bridging anticoagulation with subcutaneous low-molecular-weight heparin or unfractionated heparin can avoid dreaded complications of arterial thromboembolism (TE), but this strategy also raises risk for bleeding, raises costs, and presents logistic challenges. Retrospective cohort studies provide limited evidence to guide recommendations, and no randomized controlled trials (RCTs) have been performed.

To evaluate the 3-month cumulative incidences of TE, bleeding, and death, researchers prospectively followed a cohort of 345 patients with nonvalvular atrial fibrillation (AF) who were treated preoperatively at a single anticoagulati…