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A Bridge to Nowhere? Benefits and Risks for Periprocedural Anticoagulation in Atrial Fibrillation

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

In patients with atrial fibrillation (AF), oral anticoagulation is used to prevent stroke and systemic embolism. In a common clinical scenario, AF patients frequently undergo invasive procedures requiring temporary interruption of oral anticoagulation, thereby potentially exposing such patients to increased risk of thromboembolism. Bridging anticoagulation has been used clinically to mitigate this perceived thromboembolic risk, though this practice may also increase risk of periprocedural bleeding. High-quality data has not previously existed to inform decision-making in this clinical situation of bridging anticoagulation. We discuss recent results from the BRIDGE trial and secondary analyses from recent phase 3 randomized clinical trials of direct-acting oral anticoagulant (DOAC) use in non-valvular AF, that inform periprocedural anticoagulation with bridging strategies in AF patients. Updated data from these current trials favor against a strategy of bridging anticoagulation for elective procedures in the majority of AF patients, low or moderate in thromboembolic risk. Bridging anticoagulation is associated with an increased risk of bleeding and no decreased risk of thromboembolism.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Arun Krishnamoorthy

  2. Division of Hematology, Departments of Medicine and Pathology, Duke University School of Medicine, Durham, NC, USA

    Thomas Ortel

  3. Duke University Medical Center, Box 3422, Durham, NC, 27710, USA

    Thomas Ortel

Authors
  1. Arun Krishnamoorthy
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  2. Thomas Ortel
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Correspondence to Thomas Ortel.

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Conflict of Interest

Dr. Krishnamoorthy reported working on projects funded by research grants at the Duke Clinical Research Institute from the NHLBI, Novartis, Daiichi Sankyo, Eli Lilly, and Maquet and support to attend educational conferences from HeartWare, Thoratec, and Medtronic.

Dr. Ortel reported receiving consulting fees from Instrumentation Laboratory, CSL Behring, and Daiichi-Sankyo and grant support from the Instrumentation Laboratory, the NHLBI, and the Centers for Disease Control and Prevention.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Krishnamoorthy, A., Ortel, T. A Bridge to Nowhere? Benefits and Risks for Periprocedural Anticoagulation in Atrial Fibrillation. Curr Cardiol Rep 18, 101 (2016). https://doi.org/10.1007/s11886-016-0779-9

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  • DOI: https://doi.org/10.1007/s11886-016-0779-9

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