Bridge therapy
Formal Definition
Temporary anticoagulation using a short-acting parenteral agent (typically low-molecular-weight heparin or unfractionated heparin) during a period when a patient's long-term oral anticoagulant must be held — such as before or after a procedure — to minimize thromboembolic risk during the window of inadequate anticoagulation.
How It's Used on the Ward
"Bridge with Lovenox" or "does she need bridging?" — the question asked every time a patient on warfarin needs a procedure.
Example
""Patient on warfarin for mechanical mitral valve going to OR tomorrow: INR 2.8, needs to be <1.5 for surgery. Hold warfarin 5 days prior, bridge with enoxaparin 1mg/kg BID. Hold last Lovenox dose 24h pre-op. Resume warfarin post-op with heparin bridge until INR therapeutic.""
Clinical Context
Bridging is NOT routine — it increases bleeding risk and is only warranted for high-thromboembolism-risk patients (mechanical heart valves, VTE within 3 months, AF with prior stroke). For most AF patients, bridging increases bleeding without reducing stroke — the 2015 BRIDGE trial showed this clearly. Know your patient's thromboembolic risk score (CHA2DS2-VASc) and the procedure's bleeding risk before deciding. DOACs (apixaban, rivaroxaban) have shorter half-lives and rarely need bridging.