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● Bridging is a peri-interventional thrombosis prophylaxis in patients chronically treated with oral anticoagulants warfarin or phenprocoumon, or with the thrombocyte aggregation inhibitors aspirin or clopidogrel. These long-acting and poorly controllable drugs are replaced ("bridged") by shorter-acting low molecular weight heparins, which can be antagonized during bleeding emergencies with protamine.
● Warfarin and phenprocoumon are replaced with heparin at least 5 days and aspirin 7 days prior to the scheduled intervention.
● The heparin "bridge" is interrupted for a peri-operative period of 12-24 h.
● Heparin replacement with the original long-acting antithrombotic drug begins within 1-2 days at normal post-interventional recovery and hemostasis. In warfarin/phenprocoumon patients heparin injections are discontinued at INR=2.0.
● Note that the implementation and intensity of bridging are determined by weighing the prothrombotic against bleeding risk factors contributed both by the patient and the procedure. For example bridging is not indicated during minor dermatological interventions or minor dental procedures whereas interrupting aspirin in patients with a coronary heart disease should be avoided.
● Bridging with heparin is unnecessary for new oral anticoagulants which are discontinued for 24 h on the eve of the intervention.