American Society of Hirudotherapy

Update in bridging anticoagulation.

Research article published in Journal of thrombosis and thrombolysis (2011)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsKaatz et al. · Journal of thrombosis and thrombolysis, 2011

Abstract

Patients treated with a vitamin K antagonist may require interruption of their anticoagulation prior to an invasive procedure or surgery, and as a result, may be placed at a higher risk for thromboembolic events during this time. Either low-molecular-weight heparin (LMWH) or unfractionated heparin is frequently used to bridge the gap in anticoagulation treatment because of their relatively rapid onset and offset of action compared to warfarin. Despite the lack of randomized trials supporting the efficacy of this bridging therapy, guidelines have been developed to assist providers with this common clinical challenge. Key issues in bridging therapy include identifying patients who can safely undergo an invasive procedure while continuing their vitamin K antagonist, identifying those who will likely gain the most benefit from bridging anticoagulation, and determining the optimal dose and timing of parenteral anticoagulants in the perioperative period.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsAnticoagulantsHeparin, Low-Molecular-WeightHumansRandomized Controlled Trials as TopicThromboembolismVitamin KWarfarin

Summary

Update in bridging anticoagulation.

Why This Matters for Hirudotherapy

This review article discusses the clinical challenge of bridging anticoagulation for patients on vitamin K antagonists who require interruption of their therapy prior to invasive surgical procedures. It highlights the use of low-molecular-weight heparin or unfractionated heparin to maintain anticoagulation safely during the perioperative gap due to their rapid onset and offset of action. Because managing the delicate balance between thrombosis and bleeding is a core consideration in antithrombotic therapy, this review provides useful background on systemic anticoagulation principles relevant to any anticoagulant. However, the article contains no original data and does not mention leeches, hirudotherapy, or leech-derived anticoagulants like hirudin. Its relevance to the American Society of Hirudotherapy is strictly theoretical.

Citation

Update in bridging anticoagulation.

Kaatz et al. · Journal of thrombosis and thrombolysis, 2011

DOI

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