Surgical repair of acute hip fracture: Indications for bridging therapy

Mechanical valves
Mechanical mitral valve
Mechanical aortic valve in a patient with atrial fibrillation
Mechanical tricuspid valve
Mechanical aortic valve in a patient in sinus rhythm if it is anticipated that warfarin will not be promptly
resumed after surgery
Atrial fibrillation
CHA2DS2–VASca score 7–9 without additional bleeding risks: major bleeding event or intracerebral hemorrhage < 3 months ago; international normalized ratio above the therapeutic range; prior bleeding event from previous bridging
Any history of stroke or transient ischemic attack (ischemic or cardioembolic)
Venous thromboembolism (VTE)
VTE event within 3 months
Severe thrombophilia with history of VTE or recurrent VTE (protein C or S deficiency, antithrombin deficiency, antiphospholipid antibodies, homozygous factor V Leiden, or multiple abnormalities); consider bridging for VTE in other thrombophilias (heterozygous factor V Leiden, heterozygous factor II mutation)
History of VTE during discontinuation of anticoagulation
  • a CHA2DS2–VASc = 1 point each for congestive heart failure, hypertension, age 65–74, diabetes mellitus, vascular disease (coronary artery disease, peripheral arterial disease, aortic aneurysm), female sex; 2 points for age ≥ 75 and for prior stroke or transient ischemic attack (total possible points 9).

  • Based on information in references 38.