Submitted to the Journal of the American College of Cardiology 1/4/10

Informative (white) papers such as this (1) are often helpful although they could assist practitioners further by suggesting that clinical trials could and should be done when there is a reasonable consideration. E.g. while the authors and others (2) state that there is no reported high quality evidence-based information concerning the use of bridging dose low molecular weight heparin when platelet antagonist therapy is to be reduced or interrupted, rather than just summarily dismissing the concept of using anticoagulant medications such as bridging dose low molecular weight heparin, this type of summary or editorial piece would be a fine place to recommend that perhaps low molecular weight should be studied for just such use. The issue in this case is the statement “Bridging with anticoagulants (as a substitute for platelet antagonists), given the absence of supportive data, does not have a place in periprocedural patient management." The use of bridging dose low molecular weight heparin in exactly this circumstance would seem reasonable and is the standard format when warfarin therapy must be interrupted. In fact, instead of reducing the extent of anticoagulation with the discontinuation of the platelet antagonists clopidigrel or prasugrel, bridging dose low molecular weight heparin just might be the treatment of choice in exactly this circumstance. Appropriate research might confirm such a consideration and white papers such as these might encourage that the relevant research be done rather than simply stating or just repeating that such treatment should not be recommended.

1. Becker RC, Scheinman J, Dauerman HL et al Management of
platelet-directed pharmacotherapy in patients with atherosclerotic
coronary artery disease undergoing elective endoscopic gastrointestinal
procedures. J Am Coll of Cardiol 2009; 54:2261-2275

2. Kikano GE, Brown MT A Antiplatelet Therapy for Atherothrombotic
Disease: An Update for the Primary Care Physician. Mayo Clin Proc 2007;
82: 583-593