The use of apixaban as a perioperative bridge for warfarin in a patient unable to use parenteral anticoagulation: A case report

Abstract

Patients receiving chronic warfarin therapy for secondary venous thromboembolism (VTE) prevention often require therapeutic interruptions surrounding planned surgical procedures to mitigate the risk of hemorrhagic complications. For patients at moderate to high risk of recurrent VTE short-acting subcutaneous anticoagulants, such as low molecular weight heparins, can be utilized as a warfarin bridge to reduce the risk of periprocedural VTE. Although the efficacy of the direct oral acting anticoagulants (DOACs) for the treatment and prevention of VTE has been well established these agents have not been studied as a periprocedural bridge in patients requiring planned interruptions in warfarin therapy. We report the case of a patient required to interrupt her warfarin therapy for a procedure who highly desired VTE risk mitigation but was unwilling to utilize a subcutaneous anticoagulant. Apixaban was successfully used in place of the subcutaneous anticoagulant as a bridge during the patient's planned warfarin interruption. In the 90 days following the bridge the patient did not experience any hemorrhagic or VTE related complications.

Keywords

• Anticoagulation
• Bridging
• Direct oral acting anticoagulant
• Perioperative anticoagulation
• Warfarin