Author + information
- Marc L. Schwartz, MD∗ ( and )
- Steven W. Breecker, MD
- ↵∗Division of Cardiology, Thomas Jefferson University Hospital, Suite 1518, 1015 Chestnut Street, Philadelphia, Pennsylvania 19107
The recent comprehensive and thoughtful review by Drs. Rechenmacher and Fang (1) emphasizes that the benefit of bridging anticoagulation therapy (i.e., decreasing thromboembolic events by limiting the duration of anticoagulation interruption) must be carefully balanced against its risk of untoward periprocedural bleeding.
In our clinical experience, bleeding complications are mainly due to premature full anticoagulation in the post-procedure period. Although there is a lack of supporting data, in high-risk patients (as defined in Table 1 in their article), we use bridging anticoagulation only during the pre-procedure period. Post-procedure, warfarin alone is restarted. This approach was not noted by the authors in their review. We feel that this strategy offers the high-risk patient the benefit of pre-procedure bridged anticoagulation while limiting the risk for significant post-procedure bleeding.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation