Bridging and Warfarin Initiation

[Doctadudeman]

I have been taught that it is indicated to initiate bridging anticoagulation when starting warfarin on high risk/Chads2Vasc patients with newly diagnosed afib. I know of the BRIDGE trial with recommendations by a ACCP and ACC on bridging off of warfarin with high risk afib to surgery, but I’ve never been able to find any papers to suggest bridging parameters when restarting or initiating warfarin. Is it just assumed that the same patients will have the same risk factors and need the same amount of time to get out of the theoretical procoagulant phase of Warfarin initiation? Any papers discussing this?

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[Katheudontas parateroumen]

I would think the bridging would be the same process even for restarting. I think that’s your question? I haven’t looked up any papers about it. It’s just what is done in my practice to reconfigure heparin drip after surgery and then reintroducing WF when appropriate.

 

[Doctadudeman]

I would think the bridging would be the same process even for restarting. I think that’s your question? I haven’t looked up any papers about it. It’s just what is done in my practice to reconfigure heparin drip after surgery and then reintroducing WF when appropriate.

Haha. I know it’s an odd question but I was just thinking that we’re all just assuming this is the thing to do. I try to be as evidence based as possible, but apparently there aren’t really any hashed out guidelines. There are a lot of papers, talking about the pro coagulant phase of warfarin initiation, but I haven’t seen any algorithms or instructions about warfarin initiation from large medical studies or medical associations. I’ve even talked with some cardiologists and hematologist about this and they don’t seem to have a straight answer either. It just seems like we’re just putting the patient at risk sometimes with dual anticoagulation. I’m sure INR levels fluctuate all the time when patients aren’t being monitored and they don’t seem to have obvious issues with VTE.