A Call to Reduce the Use of Bridging Anticoagulation

Adam J. Rose*, Arthur L. Allen, Tracy Minichello

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


Because of the recent publication of several important studies, there has been a major change in how we think about perioperative management of anticoagulation. Because of these changes, existing consensus guidelines are suddenly out of date and can no longer be used as is, particularly the 2012 American College of Chest Physicians Antithrombotic Guidelines, version 9. We estimate that well over 90% of patients receiving warfarin therapy should not receive bridging anticoagulation during periprocedural interruptions of therapy, except under unusual circumstances and with appropriate justification. Accumulating evidence also suggests that bridging is not indicated among patients receiving direct-Acting oral anticoagulant therapy. The large number of patients potentially affected represents an important safety concern and requires an immediate change in practice.

Original languageAmerican English
Pages (from-to)64-67
Number of pages4
JournalCirculation: Cardiovascular Quality and Outcomes
Issue number1
StatePublished - 1 Jan 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 American Heart Association, Inc.


  • anticoagulants
  • evidence-based medicine
  • heparin
  • humans
  • low-molecular weight
  • perioperative care
  • practice guideline
  • warfarin


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