Periprocedural bridging management of anticoagulation.

More than 2.5 million Americans are chronically anticoagulated for indications including venous thromboembolism (VTE), mechanical heart valve(s), or atrial fibrillation (AF).1 Each year, 10% of these patients require temporary interruption of anticoagulation for an invasive procedure. Defining the most appropriate management strategy for these patients requires an assessment of the periprocedural risk of thromboembolism and major hemorrhage. Bridging therapy is a recent term used to describe the application of a parenteral, shortacting anticoagulant during the interruption of warfarin. In this Clinician Update, we outline a systematic approach to defining the appropriate periprocedural strategy for anticoagulation management.