Anticoagulation bridging

Question 1

Conditions requires bridging

Answer 1

Mechanical Valve	Atrial Fibrillation	VTE
MVR
Old AVR (ball cage, tilting disc)
Stroke w/in 6mos	CHADS2 5, 6
Rheumatic valve
Stroke w/in 3 mos	Clot w/in 3 mos
High risk thrombophilia
(APLA, Prot C or S, ATIII, or multiple)

Question 2

Bridging recommended

Answer 2

AVR (newer – bileaflet St Jude) with risk factor (AFib, CHADS points) CHADS 3-4 Cloth w/in 3-12 mos
Other thrombophilia
Malignancy
Recurrent VTE

Question 3

No bridging required

Answer 3

AVR, no Afib or CHADS point CHADS 1 year ago

Question 4

Bridging regiment

Answer 4

IV UFH, stop 3-6 hrs before OR
Enoxaparin 1mg/kg SQ BID
Dalteparin 100u/kg BID
Give last dose 24 hrs before OR