How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?

If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin.

If dual antiplatelet agents are contraindicated, particularly in the first month a...

The PE management is easy. Stop oral anticoagulation and place them on heparin. Hold heparin for 6-8 hours for the procedure and resume anticoagulation after the procedure (Usually in the evening).

For patients on DAPT (Dual Antiplatelet Therapy), it depends on the duration since their PCI and wheth...

1. A shorter hold than the 5-7 days.
2. Cangrelor or eptifibatide bridge.

Current-generation DES allows for short and ultra-short duration DAPT.

The guiding principle I use is balancing the periprocedural thromboembolic risk with the bleeding risk associated with surgery.

High thromboembolic risks include AF with CHADS2Vasc of greater than or equal to 7, CVA/TIA within 3 months, rheumatic heart disease, VTE within 3 months, severe thrombophil...

Where is the data for bridging?

Clearly, many scenarios are dependent, as portrayed in previous posts, and what makes sense from a pharmacodynamics and pharmacokinetic standpoint. But do we have equipoise between thrombosis and bleeding by not bridging?

Bridging for the P2Y12 inhibitor was informative. However, this scenario, in my experience, has fortunately been rare and has never been an issue. Most surgeons have opted for less invasive therapy to delay surgery past the 3-month mark after PCI.