Why is checking for bridging necessary before clearing a patient on anticoagulation (anti-clotting) therapy for sports participation?

From the Guidelines

Checking for bridging is necessary before clearing a patient on anticoagulation therapy for sports participation to prevent dangerous bleeding complications while maintaining adequate protection against thrombosis. When a patient needs to temporarily discontinue anticoagulants like warfarin, apixaban, rivaroxaban, or dabigatran for sports participation, bridging therapy with shorter-acting agents such as low molecular weight heparin (LMWH) like enoxaparin may be required. This is particularly important for high-risk patients with mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores. The bridging process typically involves stopping the oral anticoagulant 2-5 days before the activity (depending on the specific medication), administering LMWH during this period, and then resuming the original anticoagulant afterward. Without proper bridging, patients face either excessive bleeding risk during contact sports if anticoagulation is maintained or increased thrombotic risk if anticoagulation is simply stopped. The decision to bridge should be individualized based on the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports. According to the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, bridging anticoagulation may be appropriate only in patients (on warfarin) with a very high thromboembolic risk. Additionally, the BRIDGE study found that absence of bridging was noninferior to bridging with low-molecular-weight heparin for prevention of arterial thromboembolism and was found to decrease the risk of bleeding 1. Therefore, the need for bridging therapy should be carefully evaluated on a case-by-case basis, considering the patient's individual risk factors and the specific circumstances of the sports participation. Key factors to consider include the type of anticoagulant, the patient's thrombotic and bleeding risk, and the level of intensity and contact involved in the sport. By carefully weighing these factors and considering the latest evidence, healthcare providers can make informed decisions about bridging therapy to minimize the risks associated with anticoagulation in patients participating in sports. Some studies suggest that bridging therapy may expose patients to higher bleeding risks without reducing the risk of thromboembolism 1, highlighting the need for individualized decision-making. In general, the approach to bridging therapy should prioritize minimizing both thrombotic and bleeding risks, with a focus on the patient's overall morbidity, mortality, and quality of life. The most recent and highest quality study on this topic, the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1, provides guidance on the management of anticoagulation in patients with valvular heart disease, including the use of bridging therapy. Ultimately, the decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:

• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular heart disease and atrial fibrillation. These guidelines emphasize the importance of individualized decision-making and careful evaluation of the patient's thrombotic and bleeding risk. By following these guidelines and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. Some key points to consider when evaluating the need for bridging therapy include:
• The patient's thrombotic risk, including factors such as mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores
• The patient's bleeding risk, including factors such as age, kidney function, and concomitant use of antiplatelet agents
• The type of sport the patient wishes to participate in, with non-contact sports generally posing lower bleeding risks than contact or collision sports
• The latest evidence and guidelines, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1 By carefully considering these factors and prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can make informed decisions about bridging therapy and help ensure the safe and effective management of anticoagulation in patients participating in sports. The decision to use bridging therapy should be based on a thorough evaluation of the patient's individual needs and risk factors, as well as the latest available evidence. The patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in should be carefully considered, with non-contact sports generally posing lower bleeding risks than contact or collision sports. By taking a thoughtful and individualized approach to bridging therapy, healthcare providers can help ensure the safe participation of patients on anticoagulation therapy in sports. In patients with mechanical valves on long-term VKA therapy who require emergency surgery or invasive procedures, anticoagulation can be reversed by administration of intravenous prothrombin complex concentrate 1. This approach can help minimize the risks associated with bridging therapy and ensure the safe management of anticoagulation in patients with mechanical heart valves. Overall, the key to successful management of anticoagulation in patients participating in sports is a careful and individualized approach, taking into account the latest evidence and the patient's unique needs and risk factors. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can help ensure safe and effective participation in sports for patients on anticoagulation therapy. The use of bridging therapy should be guided by the latest evidence and a thorough evaluation of the patient's individual needs and risk factors. In general, bridging therapy may be necessary for high-risk patients, but the decision to use bridging therapy should be made on a case-by-case basis, considering the patient's thrombotic risk, bleeding risk, and the type of sport they wish to participate in. The patient's overall health and well-being should be the top priority, and the approach to bridging therapy should be tailored to minimize risks and optimize outcomes. By taking a thoughtful and evidence-based approach to bridging therapy, healthcare providers can help ensure the safe and effective management of anticoagulation in patients participating in sports. The latest evidence, including the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1 and the 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides guidance on the use of bridging therapy in patients with valvular

From the Research

Importance of Checking for Bridging

Checking for bridging is necessary before clearing a patient on anticoagulation therapy for sports participation because it helps to balance the risk of thromboembolism and bleeding.

• The decision to use bridging anticoagulation should be based on the patient's individual risk of thromboembolism and bleeding, as stated in the study by 2.
• Bridging therapy with low-molecular-weight heparin is usually recommended in patients who must stop oral anticoagulants before surgical or invasive procedures, according to the study by 3.

Risks Associated with Bridging

The use of bridging anticoagulation increases a patient's bleeding risk without clear evidence of thrombotic prevention among warfarin-treated patients with atrial fibrillation, as shown in the study by 4.

• A systematic review and meta-analysis found that heparin bridging therapy increased the risk of major bleeding, minor bleeding, and overall bleeding, but did not significantly reduce the risk of thromboembolic events, as reported in the study by 5.
• However, a risk-adjusted perioperative bridging regimen can reduce bleeding events without increasing thromboembolic events, as demonstrated in the study by 6.

Considerations for Sports Participation

When considering sports participation for a patient on anticoagulation therapy, it is essential to weigh the risks and benefits of bridging anticoagulation.

• The patient's individual risk of thromboembolism and bleeding should be assessed, and a bridging regimen tailored to their specific needs, as recommended by 2.
• The study by 6 suggests that a risk-adjusted bridging regimen can reduce bleeding complications without increasing thromboembolic events, which is crucial for patients participating in sports.