![]() Additional inclusion and exclusion criteria details may be found in the supplementary appendix associated with the primary publication. Exclusion criteria were presence of a mechanical heart valve stroke, systemic embolism or transient ischemic attack within the previous 12 weeks major bleeding within the previous 6 weeks creatinine clearance (CrCl) <30 mL/min platelets <100 × 10 9/L or planned cardiac, intracranial, or intraspinal surgery. ![]() We accessed the BRIDGE trial data set with the aim of identifying, apart from LMWH bridging, additional potentially-modifiable predictors of perioperative bleeding in patients with atrial fibrillation who interrupted warfarin for an elective surgery/procedure.Įligible patients were ≥18 years of age had chronic or paroxysmal atrial fibrillation or flutter confirmed by electrocardiography or pacemaker interrogation had received warfarin for at least 3 months with a therapeutic INR range of 2.0–3.0 were undergoing an elective operation or other invasive procedure that required warfarin interruption and had at least one of the following stroke risk factors: congestive heart failure or left ventricular dysfunction, hypertension, age ≥75 years, diabetes mellitus, or previous stroke, systemic embolism, or transient ischemic attack. However, their non-random allocation of patients to perioperative heparin bridging or no bridging has the potential to affect ascertainment of bleeding risk factors because the decision to bridge or not bridge is unlikely to have been independent of the presence of other bleeding risk factors. Other observational studies have evaluated risk factors for bleeding in a perioperative setting. In addition, a randomized trial of heparin prophylaxis after major abdominal surgery found that male sex, malignancy, and gynecologic or complex surgical cases conferred an increased risk of postoperative bleeding, whereas a randomized trial of perioperative aspirin use found that continuing aspirin in the perioperative period conferred a 2-fold increased risk for major bleeding. General risk factors for bleeding include active bleeding or untreated bleeding disorders, previous bleeding, severe hepatic or renal failure, thrombocytopenia, acute stroke, and uncontrolled hypertension. In addition to use of LMWH bridging, other perioperative bleeding risk factors have been previously described. Foregoing bridging with LMWH resulted in significantly less major bleeding than bridge therapy. The Bridging Anticoagulation in Patients who Require Temporary Interruption of Warfarin Therapy for an Elective Invasive Procedure or Surgery (BRIDGE) trial randomized patients with atrial fibrillation to either bridging with therapeutic-dose dalteparin or matching placebo during warfarin interruption for an elective surgery/procedure. ![]() Patients with atrial fibrillation may be susceptible to potentially avoidable thromboembolic complications during this period of warfarin withdrawal and re-initiation around a surgery or invasive procedure which led to the practice of bridge therapy with low-molecular-weight heparin (LMWH) in an attempt to mitigate this risk. As a result, there is a delay in re-establishing a therapeutic anticoagulant effect of 5–7 days after warfarin is restarted, and a longer period may be required in the post-procedure setting. Warfarin inactivates production of vitamin K-dependent clotting factors indirectly through inhibition of vitamin K epoxide reductase. Clinical practice guidelines recommend stopping warfarin 5 days prior to most surgeries/procedures to allow for normalization of the international normalized ratio (INR) and full restoration of clotting factor activity. Please check during check out, if the inquiry was saved.It is estimated that 10–15% of patients taking warfarin require temporary interruption of the anticoagulant therapy for a surgery/procedure each year. Please fill in the required information and click “save”. The granting of a best price is not combinable with other promotions (e.g. The best price enquiry will only be processed after your order has been submitted. The BEST PRICE can not be combined with Jobrad Leasing or BusinessBike Leasing.įor details about the Best Price Guarantee, please look here: The BEST PRICE can not be combined with other special offers (i.e. Black Week offers) cannot be accepted as a reference for our BEST PRICE offer. Temporary special promotions or sales campaigns run by competitors (e.g. The competitor is a professional supplier with headquarters in the Euro-Zone. The product is readily available at the competitor. The product is the same (size, colour, model year, finish etc.) as ordered. The price difference per product is €1 or more. If you find an item at a lower price with another commercial internet retailer, you will receive it from us at the same price, provided the conditions listed in the link are met.
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