6/27/23, 11:47 PM BRIDGE Pathway Feedback Search Clinical Topics Home Studies BRIDGE BRIDGE Disease Disease Disease Atrial fibrillation Deep vein thrombosis Periope Trial question Is forgoing bridging anticoagulation noninferior to perioperative bridging in patients with AF? Study design Multi-center Double blinded RCT Population Characteristics of study participants 27.0% female N = 1884 73.0% male 1884 patients (502 female, 1382 male) Inclusion criteria: patients with AF who need an interruption in warfarin treatment (5 days before the procedure) for an elective operation or other elective invasive procedure Key exclusion criteria: a mechanical heart valve; stroke, systemic embolism, or TIA within the previous 12 weeks; major bleeding within the previous 6 weeks; CrCl of < 30 mL/min; platelet count of < 100 10 /L, or planned cardiac, intracranial, or intraspinal surgery Interventions N=950 avoiding routine bridging (matching subcutaneous placebo BID) N=934 routine bridging therapy (100 IU dalteparin per kg of body weight administered SC BID from 3 days before the procedure until 24h before the procedure and then 5-10 days after the procedure) Primary outcome Arterial thromboembolism at 30 days after procedure https://web.pathway.md/studies/recTu4e1v8XGU8dTt 1/2 6/27/23, 11:47 PM BRIDGE Pathway 0.4 % 0.4 0.3 % 0.3 0.2 % Difference not exceeding nonferiority margin 0.1 % 0.0 % Avoiding routine bridging Routine bridging therapy Difference not exceeding nonferiority margin in arterial thromboembolism at 30 days after the procedure (0.4% vs. 0.3%; AD 0.1%, 95% CI -0.6 to 0.8) Secondary outcomes No significant difference in death (0.5% vs. 0.4%; AD 0.1%, 95% CI -1.1 to 1.3) No significant difference in myocardial infarction (0.8% vs. 1.6%; ARD -0.8, 95% CI -1.75 to 0.15) No significant difference in deep vein thrombosis (ARD -0.1, 95% CI -0.27 to 0.07) Safety outcomes Significant differences in major bleeding (1.3% vs. 3.2%), minor bleeding (12.0% vs. 20.9%). Conclusion In patients with AF who need an interruption in warfarin treatment (5 days before the procedure) for an elective operation or other elective invasive procedure, avoiding routine bridging was noninferior to routine bridging therapy with respect to arterial thromboembolism at 30 days after the procedure. Reference Douketis JD, Spyropoulos AC, Kaatz S et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med. 2015 Aug 27;373(9):823-33. Open reference URL https://web.pathway.md/studies/recTu4e1v8XGU8dTt 2/2