Device Surgery without Interruption of Anticoagulation

To the Editor: Birnie et al. (May 30 issue)(1) report on the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial, which showed a 16.0% rate of device-pocket hematomas in the heparin-bridging group. This rate was significantly higher than that in the continued-warfarin group (3.5%). Arguably, the rate of bleeding in the continued-warfarin group was also unacceptably high. The early resumption of therapeutic heparin 24 hours postoperatively may explain, in part, the difference in rates of bleeding. Restarting low-molecular-weight heparin bridging 12 to 24 hours after a procedure confers a 20% rate of bleeding after major surgery.(2) Resuming low-molecular-weight ...