How to manage antithrombotic treatment during percutaneous coronary interventions in patients receiving long-term oral anticoagulation: to "bridge" or not to "bridge"?

Aims: The management of patients on long-term oral anticoagulation and referred for percutaneous coronary interventions represents a substantial challenge to the physician who must balance the risks of periprocedural haemorrhage, thrombotic complications and thromboembolism. Methods and results: Currently, a standard recommendation for these patients has been the discontinuation of warfarin before invasive cardiac procedures, since uninterrupted anticoagulation is assumed to increase bleeding and access site complications. Unfractionated or low molecular weight heparins are administered as a "bridging therapy" in patients at moderate to high risk of thromboembolism. The present review summarises the available data on the safety of performing coronary interventions during uninterrupted oral anticoagulation therapy and shows that bridging therapy offers no advantage over this simple strategy and prolongs hospitalisation and may delay interventions in acute coronary syndromes. Sub-therapeutic anticoagulation during crossover phases may also increase the potential for thromboembolism. Conclusions: Bridging therapy offers no advantage over the simple strategy of performing cardiac interventions during uninterrupted therapeutic oral anticoagulation therapy.