Crossing the Periprocedural Bridge in Patients with Atrial Fibrillation

For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS₂ score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS₂ score is 5 or higher and not bridging if the CHADS₂ score is 2 or lower. But what about patients with a CHADS₂ score of 3 or 4?