For Afib Patients, to Bridge or not to Bridge? That is the Question.

Written by Bryan Heart Cardiologist, John Steuter, MD

To clarify questions and standardize patient care, in 2017, the American College of Cardiology (ACC) came forth with new guidelines and recommendations for which atrial fibrillation patients should be “bridged” during the perioperative period and which should not. The guidelines and recommendations apply to non-valvular atrial fibrillation (afib) patients undergoing surgery.

The decision about interrupting anticoagulation depends on:

1. The type of procedure being performed and risk of bleeding
2. The type of oral anticoagulant, whether vitamin K antagonist (Coumadin) or direct oral anticoagulants (DOAC) (Pradaxa, Xarelto, Eliquis)
3. If the patient is on a DOAC, the decision of when to stop the anticoagulant depends on the specific agent and renal function at the time
4. Finally, when to restart anticoagulation is addressed

Here are decision flow charts to help guide the process. For full details, refer to the 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients with Nonvalvular Atrial Fibrillation.

Bryan Heart provides a full spectrum of treatment options for patients with afib. To refer a patient for evaluation and treatment as needed, call Bryan Heart at 402-483-3333.