Perioperative Anticoagulation for Atrial Fibrillation

Abstract This chapter examines the BRIDGE trial, which compares the effectiveness of bridging anticoagulation with low-molecular-weight heparin to not bridging in patients with atrial fibrillation undergoing elective procedures. It finds that, for patients with a CHADS2 score below 4, foregoing bridging anticoagulation is noninferior to using low-molecular-weight heparin and reduces the risk of major bleeding. The trial included 1,813 patients and showed that the no-bridging group had significantly lower major bleeding rates. However, the chapter cautions that the trial’s results may not apply to patients with higher CHADS2 scores or those undergoing high-risk surgeries. Finally, the chapter concludes that foregoing bridging anticoagulation is a viable option for most patients undergoing low-risk procedures but requires caution in high-risk cases.