Rethinking Bridging

[Protimenow]

In previous posts that asked about bridging, I took the position that if the bridging was done so you wouldn't have a clot form on your valve in the three days between a procedure and full anticoagulation, you really didn't need to bridge.

OTOH -- if there's a risk of clot formation after a procedure (something that they would give an unanticoagulated person heparin to prevent, bridging should be done.

I'm getting a biventricular pacemaking device in a few weeks. My cardiologist seems to want me to bridge. (He did my current pacemaker implantation when I was fully anticoagulated). I think he wants this out of an abundance of caution. IF there's a risk that I might throw a clot after the procedure, I'll bridge for a day or two -- I'll see if he'll agree to do it if I bring my INR to around 2.0.

But again, if the procedure is one that other patients get heparin for, bridging makes sense.

My opinion regarding bridging has softened a bit.

Nobog, vitdoc, others, any comments you'd like to make?

 

[pellicle]

My opinion regarding bridging has softened a bit.

Nobog, vitdoc, others, any comments you'd like to make?

since 2017 I don't bridge, I manage my INR. This is done because I know myself and my INR reaction because I self test and rigorously document.

https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
based on this Chuck took it further (and I wrote it up here)

https://cjeastwd.blogspot.com/2022/05/rapid-dust-off-inr-management.html
Bridging (as identified in the first of thos two posts) is associated with poor outcomes statistically. I regard bridging as being akin to anxiety driven behaviour ... meaning worry because you don't know and don't have any data.

This is not medical advice.

Best Wishes

 

[Protimenow]

As I said at the start of my first message, I was advising that in most cases bridging is unnecessary -- resuming the normal dose returns you to your target INR in a few days.

I was concerned about procedures with a high risk of clot formation shortly after the procedure. In a case like this, if there really are cases like this, heparin may be necessary.

But if the procedure isn't one where the patient isn't given heparin, I see no good reason to bridge. I didn't bridge for a few minor procedures in the past and probably won't when I get my biventricular pacemaker.

 

[pellicle]

As I said at the start of my first message, I was advising that in most cases bridging is unnecessary --

and my post was agreeing with you and providing other readers with the logic and medical literature research evidence as to why I was in agreement.

Bridging is the low hanging fruit for people who can't manage INR.