Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

Patients with afib undergoing elective surgery or invasive procedure who were on coumadin were randomized to bridging with low molecular weight heparin or placebo preoperatively.  The incidence of arterial thromboembolism was .03% in the bridge group and 0.4% in the placebo group, demonstrating non-inferiority of placebo.  The bleeding complication rates were higher in the bridge group, 3.2% vs 1.3%.  Not bridging was non-inferior to bridging and reduced the risk of bleeding complications.