Potential disadvantages of perioperative heparin bridging

Potential disadvantages of perioperative heparin bridging

Some of the potential disadvantages of perioperative heparin bridging are risk of thromboembolism due to subtherapeutic dose, more prolonged total hospital stay and cost as well as inconvenience of heparin therapy.

In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively low bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anesthesia is one such potential situation in which the bleeding risk is very low. Ablation of atrial fibrillation is a situation in which the thrombotic risk is high.