A Bridge Too Far? Findings of Bridging Anticoagulation Use and Outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
In the current issue of Circulation, Steinberg et al. describe use and outcomes associated with bridging anticoagulation (AC) in patients with atrial fibrillation (AF) in the contemporary Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF)1. Chronic oral anticoagulation (OAC) significantly reduces the risk of stroke or thromboembolism in patients with atrial fibrillation (AF). Despite the growing population burden of AF2, increasing use of OAC, and frequent need for cardiac and non-cardiac procedures in this population, remarkably little contemporary data exist to help guide the clinician with respect to peri-procedural AC decision-making. Although guidelines exist on the topic, they are based on limited and largely observational data3,4. Current guideline-supported peri-procedural AC management supports discontinuation of OAC and the use of short-acting AC, most commonly low-molecular weight heparin or unfractionated heparin, to 'bridge' AF patients at high risk for thromboembolic complications during the immediate pre- and post-procedure period (ACCP Grade 2C; AHA Grade 1C)3,4.
- Received December 9, 2014.
- Accepted December 9, 2014.