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No validated approach exists for the interruption of oral anticoagulants in patients who require surgery or invasive procedures. In this study, investigators at 22 sites in Italy agreed on a bridging protocol and collected prespecified outcomes data on 1262 consecutive oral anticoagulant recipients undergoing various procedures.
Oral anticoagulants were discontinued 5 days before the procedure. Low-molecular-weight heparin (LMWH), 70 U/kg twice daily in patients at high thromboembolic risk (23% of participants) or 57 U/kg once daily in patients at low-to-intermediate thromboembolic risk (77% of participants), was initiated 1 or 2 days later and continued up to 12 hours before the procedure. LMWH was resumed 1 or 2 days postprocedure and cont…