Background: The prevalence of anticoagulant use has increased in the United States.
Medical providers have the responsibility to explain to patients the management of anticoagulant
regimens before an invasive procedure. The pharmacologic characteristics of these medications,
specifically their half-lives, are important in timing an interruption of anticoagulant therapy.
Objective: The authors review the current guidelines and recommendations for therapeutic interruption
of anticoagulants and the involved pharmacologic factors.
Methods: Guidelines and other literature are summarized with discussion on the pharmacology of
each medication. Recommendations on how and when to provide bridging for anticoagulants are
discussed. Newer oral anticoagulants also are discussed, along with interruption recommendations.
Results: Literature reveals a conservative approach for using bridging when anticoagulation is interrupted
because of higher risks of bleeding. Caution is advised when resuming anticoagulant therapy
when neuraxial anesthesia is used.
Conclusion: Perioperative healthcare providers need to balance risks and benefits of anticoagulant
therapy with its interruption preoperatively.
Keywords: Anticoagulants, bleeding risk, bridging therapy, direct thrombin inhibitors, factor Xa inhibitors, heparin, neuraxial
anesthesia, perioperative care, surgery, warfarin.
Rights & PermissionsPrintExport