Author + information
- Stephen J. Rechenmacher, MD∗ ( and )
- James C. Fang, MD
- ↵∗Department of Cardiology, University of Utah Health Science Center, 30 N 1900 E, Room 4A100, Salt Lake City, Utah 84132
We appreciate the interest of Drs. Schwartz and Breecker in our review (1) and appreciate their approach to anticoagulation bridging. Their practice of pre-procedural–only bridging may reduce thrombotic events without causing hemorrhagic complications, and could be considered along with the alternative strategies described in our review (Figure 3 ). However, because the risk of bleeding and thrombosis varies considerably throughout the periprocedural period, only until a prospective randomized trial of any bridging practice is studied can a specific practice be embraced. We agree that the attenuation of thromboembolism risk with bridging immediately post-procedure may paradoxically increase the bleeding risk during this most vulnerable period for bleeding. For this reason, we emphasize the importance of individually tailoring anticoagulation therapy to the patient, procedure, and dynamic risk of bleeding and thrombosis. In many, if not most, situations, warfarin interruptions and bridging anticoagulation can be avoided (Central Illustration ).
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