Interesting study on bridging for surgery with low molecular weight heparin

[vitdoc]

https://ashpublications.org/blood/a...5575/Double-Blind-Randomized-Control-Trial-of
The study looked at bridging for surgery patients on warfarin with A Fib and mechanical valves.
Moderately well powered showing little difference in thromboembolic complications with A Fib or valve patients.

Should we get bridging therapy for surgery being on warfarin?

 

[Protimenow]

Personally, I don't like the idea of bridging. There's very little risk of stroke or other negative events for 10 or more days with an INR below 2.0, according to a study by Duke Clinic.

After a procedure, restarting Warfarin at the usual dose brings the INR (mine, at least), back into range.

I've resisted bridging for a few procedures, and had no trouble bringing my INR into range in the next few days.

Recently, I had an attempted ablation, and my electrophysiologist insisted that I bridge before and after the procedure. I humored him, getting 8 syringes with enoxaparin - costing me $100 co-pay. I used ONE syringe - and didn't really need that. As expected, returning to my usual dose of Warfarin brought me back into range within the next three days.

Personally, unless I'm having multiple procedures, where normal clotting is important, and where the INR must remain low for a week or so, I wouldn't bridge.

Perhaps medical recommendations should be upgraded.

OTOH, it doesn't hurt the surgeons to cover their asses by insisting on bridging, because even if the risk of thromboembolic events is nearly zero, they can't be accused of an event that never happened.

 

[slipkid]

Personally, I don't like the idea of bridging. There's very little risk of stroke or other negative events for 10 or more days with an INR below 2.0, according to a study by Duke Clinic.

After a procedure, restarting Warfarin at the usual dose brings the INR (mine, at least), back into range.

I've resisted bridging for a few procedures, and had no trouble bringing my INR into range in the next few days.

Recently, I had an attempted ablation, and my electrophysiologist insisted that I bridge before and after the procedure. I humored him, getting 8 syringes with enoxaparin - costing me $100 co-pay. I used ONE syringe - and didn't really need that. As expected, returning to my usual dose of Warfarin brought me back into range within the next three days.

Personally, unless I'm having multiple procedures, where normal clotting is important, and where the INR must remain low for a week or so, I wouldn't bridge.

Perhaps medical recommendations should be upgraded.

OTOH, it doesn't hurt the surgeons to cover their asses by insisting on bridging, because even if the risk of thromboembolic events is nearly zero, they can't be accused of an event that never happened.

I found bridging to be extremely difficult for many reasons I won't go into, as well as being absolute torture. Going through all that again has dissuaded me from ever having any types of procedures that require it unless beyond my control/no choice.

If not really nec depending on the issue/time duration I need to research that more etc & make up my own mind about willing to take the risk or not, because as you say medical professionals do all kinds of stuff for no good reason other than covering their own asses following protocols which in some cases are not even necessary other than to prevent them from being sued and losing the lawsuit.

 

[pellicle]

Should we get bridging therapy for surgery being on warfarin?

I'm not sure if it's just the phrasing here, but the study you cited concludes

Conclusions​

In patients with atrial fibrillation and/or mechanical heart valves who had warfarin interrupted for a procedure there was no benefit from post-procedure LMWH bridging.​

previously I've cited other studies saying
https://www.nps.org.au/australian-p...e-perioperative-management-of-anticoagulation

Do the benefits of anticoagulation outweigh the risks?

The approach to the management of anticoagulation in patients with prosthetic valves undergoing non-cardiac surgery remains controversial. The need for perioperative anticoagulation in patients with mechanical heart valves has been questioned in a recent review. The authors argue that for every 10 000 patients with mechanical heart valves who are given perioperative intravenous heparin, three thromboembolic events are prevented at the cost of 300 major postoperative bleeding episodes

My own personal discussion on that article is here
http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html