??bridge therapy for patients on warfarin and invasive procedures
A pretty common primary care conundrum is what to do with patients who are on warfarin but have impending surgery: stop the warfarin and hope they don't get a pulmonary embolus, or do bridge therapy (there are several different ways to do the bridging: for those at high risk of venous thromboembolism --VTE, full-dose bridging is often done: stopping the warfarin 5 days prior to surgery, starting low molecular-weight heparin soon thereafter, stopping that for the surgery, and then restarting the heparin soon after the surgery (can be 1 day in those at low risk of post-op bleeding, longer if at higher risk); can do prophylactic low-dose heparin post-op; or can do intermediate (about 1/2 full-dose) for those with higher risk (eg VTE within the past month). Warfarin is resumed 12-24 hours post-op and usually takes 4-6 days to achieve target anticoagulation. A recent study in JAMA Internal Medicine looked at the outcome of 1178 patients in a retrospective cohort stu...