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Patients with atrial fibrillation, mechanical prosthetic heart valves, and other conditions are commonly treated with a vitamin K antagonist (VKA) to reduce the risk of stroke. When these patients must undergo surgery, the physician is faced with a dilemma: continuing VKA therapy increases the bleeding risk, whereas discontinuing it increases stroke risk. Bridging therapy is the use of an alternative anticoagulant agent in the perioperative period designed to reduce the risk of stroke without substantially increasing bleeding. This slide kit, created by Alex C. Spyropoulos, MD, FACP, covers important issues related to bridging therapy and examines the results of recent trials of bridging therapy with a variety of agents. |