Bridge or Not?

For direct oral anticoagulants you usually don't have to bridge because they're again very short acting. For warfarin it's much more common since you're stopping 5 to 7 days usually before the procedure. People with a Chads VASK score of 5 or 6 or a prior history of stroke, TIA or systemic embolus more than 3 months out have a 5 to 10% risk per year. So that's what you basically want to take into account more than anything is if they're in that intermediate category 5 to 10%. The evidence would suggest that bridging is associated with definitely increased risk of bleeding without a ton of protection against thrombosis.