Issue: 2011 > June > review

Periprocedural reversal and bridging of anticoagulant treatment

M. Levi, E. Eerenberg, P.W. Kamphuisen


Anticoagulants are effective agents in reducing the risk
of thromboembolism but the most important adverse
effect of these agents is the occurrence of bleeding.
Bleeding complications may occur spontaneously but
the risk of bleeding is particularly increased in case of
trauma or around invasive procedures. If patients being
treated with anticoagulants need to undergo an invasive
intervention, physicians need to consider whether to
interrupt the use of this medication or to allow its use
to be continued. Suspending the use of anticoagulants
increases the risk of thrombosis, whereas continued use
may cause bleeding complications. To shorten the period
in which anticoagulant treatment is interrupted, bridging
strategies have been advocated. No evidence-based scientific research has been carried out regarding best practice for the perioperative use of anticoagulants. The periprocedural anticoagulation policy in patients should be individualised based on the risk of a thromboembolic complication (which can be estimated with available scoring systems) offset against the bleeding risk associated with the intervention.