Periprocedural management of the chronically anticoagulated patient: critical pathways for bridging therapy.

Periprocedural bridging of the patient on long-term anticoagulation is indicated in nonvalvular atrial fibrillation with additional risk factors, prosthetic heart valves, venous thromboembolism within 3 months of the procedure, and hypercoagulable conditions requiring oral anticoagulation. Until recently, intravenous unfractionated heparin was used for bridging. LMWH has now emerged as a safe and effective bridging alternative.