Abstract
Meta-analyses of cohort studies and a recent randomized, placebo-controlled study have shown that perioperative bridging of warfarin therapy with therapeutic doses of heparin results in a multi-fold increase in major bleeding but no reduction in the incidence of thromboembolism. It is time to reconsider heparin bridging: When is heparin bridging superfluous? When is prophylactic dosage indicated? And when is it safe to use therapeutic dosing?
MeSH terms
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Anticoagulants* / administration & dosage
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Anticoagulants* / adverse effects
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Anticoagulants* / therapeutic use
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Hemorrhage / chemically induced
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Hemorrhage / prevention & control
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Heparin / administration & dosage
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Heparin / adverse effects
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Heparin / therapeutic use
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Heparin, Low-Molecular-Weight* / administration & dosage
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Heparin, Low-Molecular-Weight* / adverse effects
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Heparin, Low-Molecular-Weight* / therapeutic use
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Humans
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Perioperative Care*
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Thromboembolism / prevention & control
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Vitamin K / antagonists & inhibitors
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Warfarin / administration & dosage
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Warfarin / adverse effects
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Warfarin / therapeutic use
Substances
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Anticoagulants
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Heparin, Low-Molecular-Weight
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Vitamin K
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Warfarin
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Heparin