Bridging therapy is used in which scenario?

• A. For chronic outpatient VTE treatment
• B. When patients are too unstable for PO or require invasive procedures
• C. For dental prophylaxis
• D. For primary prevention of stroke in Afib

Answer: (B)

Bridging therapy centers on maintaining anticoagulation when the usual long-acting oral agent must be paused or cannot be used. In this approach, a short-acting anticoagulant such as unfractionated heparin or low-molecular-weight heparin is given to cover the period of risk, then therapy is resumed once it’s safe. This is particularly valuable when a patient cannot take oral medications or is facing an invasive procedure where bleeding risk is higher. The goal is to protect against thromboembolism without leaving a window of no protection.

If a patient is already on chronic outpatient VTE treatment, bridging isn’t routinely used because the need is ongoing anticoagulation rather than a temporary gap, and bridging adds bleeding risk. For dental prophylaxis or for primary prevention of stroke in atrial fibrillation, bridging is not the standard approach; these situations are managed by adjusting or temporarily holding the oral anticoagulant as appropriate rather than bridging with short-acting agents.