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By Gan Dble Rfrftftftft
James D Douketis, Alex C Spyropoulos, Scott Kaatz, Richard C Becker, Joseph A Caprini, Andrew S Dunn, David A Garcia, Alan Jacobson, Amir K Jaffer, David F Kong, Sam Schulman, Alexander G G Turpie, Vic Hasselblad, Thomas L Ortel
BACKGROUND: It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS: We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure...
August 27, 2015: New England Journal of Medicine
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