🌉 Perioperative Anticoagulant/Antiplatelet Bridging
UseDecide whether and how to interrupt and bridge anticoagulation around surgery, balancing bleeding against thr…
SourceDouketis JD, et al. Perioperative management of antithrombotic therapy, CHEST. 2022
This-shift next steps
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Methodology · worked example, guidelines & full notes
Most atrial fibrillation does not need bridging.
When to use
Decide whether and how to interrupt and bridge anticoagulation around surgery, balancing bleeding against thrombosis.
How it works
Warfarin: stop ~5 days pre-op, bridge only if high thrombotic risk. DOAC: stop 1–4 days by drug/renal function/bleeding risk, no bridging.
Key points
- Most atrial fibrillation does not need bridging.
- Bridge only mechanical valves, recent VTE or recent stroke/TIA.
- Do not stop dual antiplatelet therapy unilaterally for recent stents — co-decide with cardiology.
- DOACs act fast and resume quickly without bridging.
References
- [Guideline / primary source]Douketis JD, et al. Perioperative management of antithrombotic therapy, CHEST. 2022
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | DOAC interruption & resumption |
|---|
→Key pointPerioperative DOAC interruption & resumption
- Xa inhibitors (apixaban/rivaroxaban/edoxaban)：CrCl ≥ 30: stop 1 day (low bleeding risk) or 2 days (high)
- Dabigatran：CrCl ≥ 50: low 1 / high 2 days; CrCl 30–50: low 2 / high 4 days
- Resume：Post-op 1 day (low bleeding risk) or 2–3 days (high); DOACs act fast — no bridging needed
| View | Warfarin bridging |
|---|
→Key pointPerioperative warfarin bridging
- Stop：Stop warfarin ~5 days before surgery (until INR < 1.5)
- Bridging indication：Bridge only if high thrombotic risk: mechanical valve, VTE within 3 months, stroke/TIA within 3 months, rheumatic valve disease; most AF is not bridged
- Bridging method：Therapeutic-dose LMWH, last dose 24 h pre-op (give half the dose)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Perioperative Anticoagulant/Antiplatelet Bridging?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Perioperative Anticoagulant/Antiplatelet Bridging upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Perioperative Anticoagulant/Antiplatelet Bridging calculated in practice? Can you show a worked example?
- Inputs: View DOAC interruption & resumption → Result: Key point Perioperative DOAC interruption & resumption（Xa inhibitors (apixaban/rivaroxaban/edoxaban): CrCl ≥ 30: stop 1 day (low bleeding risk) or 2 days (high), Dabigatran: CrCl ≥ 50: low 1 / high 2 days; CrCl 30–50: low 2 / high 4 days, Resume: Post-op 1 day (low bleeding risk) or 2–3 days (high); DOACs act fast — no bridging needed） Inputs: View Warfarin bridging → Result: Key point Perioperative warfarin bridging（Stop: Stop warfarin ~5 days before surgery (until INR < 1.5), Bridging indication: Bridge only if high thrombotic risk: mechanical valve, VTE within 3 months, stroke/TIA within 3 months, rheumatic valve disease; most AF is not bridged, Bridging method: Therapeutic-dose LMWH, last dose 24 h pre-op (give half the dose)）