Bridge therapy

Bridge therapy is a medical management strategy often used in patients who are on long-term anticoagulation therapy and require an interruption of this therapy for an upcoming surgical or invasive procedure. The goal of bridge therapy is to minimize the time a patient spends in a subtherapeutic range, thus reducing the risk of thromboembolism, while also minimizing the risk of bleeding complications associated with the procedure.

Indications

Bridge therapy is typically indicated in patients with a high risk of thromboembolism, such as those with mechanical heart valves, atrial fibrillation, or a history of venous thromboembolism, who require interruption of their anticoagulation therapy for a procedure. The decision to use bridge therapy should be individualized based on the patient's risk of thromboembolism and bleeding.

Procedure

Bridge therapy typically involves the temporary substitution of a short-acting anticoagulant, such as low molecular weight heparin (LMWH) or unfractionated heparin, for the patient's usual long-term anticoagulant. The short-acting anticoagulant can be discontinued closer to the time of the procedure and restarted sooner after the procedure, thus minimizing the time the patient spends in a subtherapeutic range.

Risks

While bridge therapy can reduce the risk of thromboembolism, it is associated with an increased risk of bleeding complications. Therefore, the decision to use bridge therapy should be made in consultation with the patient and should take into account the patient's individual risk factors.

See also

• Anticoagulation
• Thromboembolism
• Low molecular weight heparin
• Unfractionated heparin