Bridging of anti-coagulation therapy

Please state the nature of the procedure, for which bridging therapy is required and the name of the responsible clinician.

Note that referrals will almost always be from the specialist setting undertaking the procedure, but please see ‘Who not to refer’ for advice about minor procedures, too.

Who to refer, who not to refer, how to refer

Who to refer:

Patients requiring surgery on long-term warfarin for:

prosthetic heart valves;
venous thromboembolism who require major elective surgery
Thrombophilia e.g. antiphospholipid syndrome

Patients on direct oral anticoagulants and recent thrombosis (less than 3 months)

Who not to refer:

Do not refer patients undergoing minor procedures for which anticoagulation does not require to be interrupted e.g.

endoscopy without biopsy or minimal/small biopsies (refer to British Society of Gastroenterology Guidelines)
patients requiring routine dental extraction or minor dermatological procedures e.g. small skin biopsies, removal of minor skin lesions.

In such cases warfarin may be continued but the INR should be checked within 24 hours of the procedure.

How to refer:

SCI Gateway

Primary care management

Primary care investigations

Initial investigations – normally done by the specialist arranging the procedure:

FBC
INR and full coagulation profile
U&Es
Weight (Kg)

Last reviewed: 17/01/2025

Next review date: 17/01/2027

Author(s): Charlotte Robertson.