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).
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