Bridging of Antithrombotic Therapy in Patients with Cardiovascular Disease. Position paper

In patients who need antithrombotic therapy for cardiovascular diseases (anticoagulants or antiplatelet therapy) perioperative consideration of the bridging strategy is mandatory. The risks of thromboembolism and bleeding have to be taken into account. Periprocedural management depends on the urgency of the procedure. In emergency cases the operation has to be done in spite of antithrombotic therapy. In patients who need antithrombotics only for a limited period of time, an elective procedure could be performed after the time of anticoagulation or dual antiplatelet therapy. If heart valve replacement or coronary stenting is performed in a patient with known future need of an elective procedure, devices should be preferred for implantation which need antithrombotics only for a short time post implantation. In all other cases the risk of bleeding and the risk of throm-boembolism should be balanced: In patients at low risk for a thromboembolic event, cessation of effective antithrombotic therapy is reasonable. However, patients with intermediate to high risk for thromboembolic events need specific bridging treatment depending on the risk of bleeding. Continuation of antithrombotics often increases just the risk of mild to intermediate bleeding, but it prevents occurrence of life-threatening thromboembolic events. For optimal periprocedural treatment of patients on anticoagulants or antiplatelet therapy cooperation of the medical disciplines involved is mandatory.