Perioperative Anticoagulation in Atrial Fibrillation: A Bridge to Nowhere

In the U.S., many warfarin-treated patients with atrial fibrillation (AF) who undergo elective surgery receive perioperative bridging anticoagulation, despite a paucity of evidence supporting this practice. In this randomized trial, researchers evaluated >1800 warfarin-treated adults with AF and CHADS₂ (congestive heart failure, hypertension, age ≥75, diabetes, stroke) scores ≥1 who were undergoing elective invasive procedures or surgery.

Patients were bridged with subcutaneous dalteparin (Fragmin) or placebo from 3 days before their procedures until 24 hours before their procedures; bridging was resumed at 1 or 2 days after procedures and was continued until patients achieved full warfarin anticoagulation. Patients with recent arterial or v…