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patients with atrial fibrillation are at increased risk of stroke to reduce that risk warfarin anticoagulation is often used but when these patients require surgery or an invasive procedure warfarin usually has to be stopped perioperative lee the question then is what to do about anticoagulation a frequent practice is to bridge the patient temporarily with heparin around the time of surgery but is that necessary the bridge trial was designed as a non-inferiority study to answer that question 1884 patients with atrial fibrillation were randomized to receive either subcutaneous low molecular weight heparin or placebo injections twice a day while their warfarin was being withheld the warfarin was stopped five days before surgery and restarted within 24 hours after surgery the primary outcomes were arterial thrombosis amande major bleeding the incidence of arterial thrombosis Ammaamp;#39;s 0.3% in the low molecular weight heparin group and 0.4% in the placebo group the incidence of major
