In this uncontrolled trial of 1262 patients on oral anticoagulants undergoing a variety of procedures, patients were assigned to a standard protocol for peri-procedural bridging, and followed for 30 days to assess bleeding or thromboembolism. Oral anticoagulants were stopped 5 days before the procedure, and LMWH was started 3-4 days before the procedure (and stopped 12 hours before; the dose was 70U/kg BID in high thromboembolic risk, and 57 U/kg Qday in low-intermediate risk). LMWH was re-started 1 day post-procedure for 6 days or until therapeutic INR. Oral anticoagulants were also resumed 1 day post-procedure at 50% higher dose for 2 days. Thromboembolism occurred in 0.4% (none of which had appropriate LMWH administered), and major bleeding occurred in 1.2% (none of which were fatal). This protocol seems safe and effective for peri-procedural bridging (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.