The Hemophilia and Thrombosis Center of Nevada

2020 W. Palomino Lane Suite 110

Las Vegas, Nevada 89106

702-385-2702

since May 5, 2008

Last updated May 5, 2008

webmaster RIS

What Is It??   BRIDGE THERAPY

Bridge therapy is ordered when a patient who is at high risk of clotting needs to have the warfarin interrupted for a period of time.  This may be in preparation for a procedure, such as a surgery, endoscopy, colonoscopy, dental procedure, or other procedure where the treating physician feels that proceeding while the patient is on warfarin may be dangerous resulting in bleeding complications.  Normally the warfarin would be discontinued three days prior to the procedure and resumed at the discretion of the surgeon the day of or after the surgery.  Stopping the warfarin will lower the INR and also lower the risk of bleeding.  However, in patients at very high risk of clotting, these several days of being off anticoagulant therapy may result in a blood clot.  For this reason, bridge therapy is ordered.

In bridge therapy, the warfarin is discontinued and when the INR drops below the therapeutic level, heparin (usually low molecular weight heparin which may be easier administered at home) is instituted.  The heparin is discontinued on the day of the procedure (or the day before depending upon the timing and the planned procedure) and resumed later that day, or the next day.  This protects the patient from developing a blood clot while off anticoagulant therapy as the blood is thinned by the heparin until the warfarin is therapeutic in the body.

Bridge therapy should only be used in persons at very high risk of clotting.  Heparin carries a risk of bleeding that may not be worthwhile using it in all patients.  Patients that benefit from bridge therapy are those that have had a recent blood clot, within the past month, and those patients that have had recurrent blood clots.

Most insurances cover the cost of this treatment, with the exception of medicare which does not pay for the cost of the heparin product.

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Last modified: March 02, 2008