Perioperatief beleid wijzigen bij orale antistolling? De BRIDGE-studie ter discussie

Abstract

The management of anticoagulation in patients undergoing invasive procedures is a complex clinical problem. Interrupting anticoagulation for a procedure increases the risk of thromboembolism. On the other hand, bridging anticoagulation with an alternative, short-acting anticoagulans increases the risk for peri-operative bleeding. A recent randomized controlled trial (the BRIDGE trial) shows that in patients with atrial fibrillation who had anticoagulant treatment interrupted for an elective invasive procedure, a strategy of forgoing bridging anticoagulation decreased the risk of major bleeding and was non-inferior to peri-operative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism. However, the study deserves comment. First, most of the patients were classified at low risk for thromboembolism, with a mean CHADS2-score of 2.3. Second, the majority of the procedures were low bleeding risk procedures. Whether bridging anticoagulation is helpful for patients with moderate to high-risk for thromboembolism undergoing high bleeding risk procedures remains unanswered.