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Patients on warfarin or direct-acting oral anticoagulants (DOACs) who are undergoing surgical procedures might be bridged with low-molecular-weight heparin (LMWH) while their oral anticoagulants are held. This used to be the standard of care, but numerous trials — particularly atrial fibrillation (AF) ablation trials — have shown that bridging actually might be associated with worse outcomes. However, for non-electrophysiology procedures, bridging is still frequently performed.
In a randomized controlled trial (RCT) performed in Canada and India, 1471 patients with AF (79%) or mechanical heart valves (21%) on warfarin were randomized to LMWH or placebo after a surgical procedure for which the surgeon wanted warfarin interrupted. All patients…