Key result
The evidence base for bridging anticoagulation in patients on chronic vitamin K antagonists requiring surgery is deficient, highlighting the need for prospective multi-centre controlled studies.
Why the study?
What is the current evidence and optimal management strategy for bridging anticoagulation in patients on chronic vitamin K antagonists or novel oral anticoagulants undergoing invasive procedures?
What is the current evidence and optimal management strategy for bridging anticoagulation in patients on chronic vitamin K antagonists or novel oral anticoagulants undergoing invasive procedures?
Highlights the deficient evidence base for bridging anticoagulation and emphasizes the need for prospective studies, particularly regarding the peri-procedural management of novel oral anticoagulants.
Evidence for bridging remains deficient; leaves open optimal periprocedural strategies pending RCTs and NOAC data.
For patients prescribed chronic vitamin K antagonist therapy requiring a surgical or invasive procedure, the question of whether or not to bridge and how to bridge is commonly encountered in clinical practice. Bridging anticoagulation has evolved over the years and the evidence base for current practice is deficient in many areas. Clinical trials currently being completed with conventional anticoagulants should help strengthen the evidence base for future practice. The availability of novel oral anticoagulants is a welcome addition, though their optimal management peri-procedure is yet to be determined. Prospective multi-centre controlled studies that can provide the evidence base for novel oral anticoagulant peri-procedural management are required.
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Patel et al. (2013) conducted a review in Patients prescribed chronic vitamin K antagonist therapy requiring a surgical or invasive procedure. Bridging anticoagulation was evaluated. The evidence base for bridging anticoagulation in patients on chronic vitamin K antagonists requiring surgery is deficient, highlighting the need for prospective multi-centre controlled studies.
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