Document Detail

Bridging therapy and oral anticoagulation: current and future prospects.
MedLine Citation:
PMID:  20613508     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Patients undergoing oral anticoagulation treatment with vitamin K antagonist (VKA) therapy are at a high risk of bleeding when undergoing an invasive surgery or procedure. Bridging therapy with parenteral heparin, usually at therapeutic doses, aims to protect these patients against thromboembolism during temporary periprocedural interruption of VKA therapy. Whether or not to interrupt VKA therapy and initiate bridging therapy is a difficult decision that is based upon both the patient's and the procedure's thromboembolic and bleeding risks.
RECENT FINDINGS: There are minor procedures that can safely be done without the need for VKA interruption. Patient groups that may benefit from bridging therapy during temporary VKA interruption for a procedure include those who are at moderate-to-high risk of thromboembolism. Procedural bleed risk should determine when to resume bridging and VKA therapies. Recent findings highlight that low-molecular-weight heparin, usually in the outpatient setting, is the preferred agent over intravenous unfractionated heparin for bridging therapy, which includes patients with prosthetic heart valve indications for VKA therapy.
SUMMARY: Large, recently initiated placebo-controlled trials in bridging therapy are discussed, as well as future alternatives to VKA therapy in oral anticoagulation during the periprocedural period.
Alex C Spyropoulos
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in hematology     Volume:  17     ISSN:  1531-7048     ISO Abbreviation:  Curr. Opin. Hematol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-12     Completed Date:  2010-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9430802     Medline TA:  Curr Opin Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  444-9     Citation Subset:  IM    
McMaster University, Department of Medicine, Hamilton General Hospital Thrombosis Unit, Hamilton, Ontario, Canada.
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MeSH Terms
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects*
Blood Loss, Surgical / prevention & control*
Drug Administration Schedule
Heparin, Low-Molecular-Weight / administration & dosage*
Preoperative Care
Vitamin K / antagonists & inhibitors
Warfarin / administration & dosage,  adverse effects*
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 12001-79-5/Vitamin K; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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