Utilidad de la heparina como terapia anticoagulante puente en la fibrilación auricular

Atrial fibrillation is associated with a 5-6 fold increase of stroke risk and as such is the most common cause of cardioembolism. Warfarin anticoagulation reduces this risk by nearly 70%. Patients with atrial fibrillation however often require temporary warfarin interruption for an invasive procedure. This scenario is a common clinical problem, affecting nearly 400 000 patients in North America each year. The use of bridging heparin therapy reduces the time interval off anticoagulants and thereby theoretically reduces the risk of peri-procedural cardioembolic events. Yet not all patients require this form of therapy. Conditions increasing the risk of periprocedural thrombosis in patients with atrial fibrillation include mechanical heart valves, history of prior arterial embolism or stroke, known intracardiac thrombus, and high composite CHADS2 score (≥ 4). For anticoagulated patients with non valvular AF requiring an invasive procedure, one should consider bridging heparin therapy only for those patients at the highest risk of thromboembolism. Patient management must be individualized balancing both the patient-specific and procedure-specific risks of bleeding and thrombosis when making these recommendations. Copyrigth