Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation
N Engl J Med. 2015 Aug 27;373(9):823-33.

Douketis JD(1), Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, Garcia DA, Jacobson A, Jaffer AK, Kong DF, Schulman S, Turpie AG, Hasselblad V, Ortel TL; BRIDGE Investigators.

It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. In this study, funded by National Heart, Lung, and Blood Institute of the National Institutes of Health, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding in patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure.