Perioperative anticoagulation—are we at 'a bridge too far'?

The perioperative management of patients with atrial fibrillation who require an elective surgical or other invasive procedure is an area of ongoing uncertainty. Accumulating evidence from observational studies suggests that the use of bridging anticoagulation with heparin, although well-intentioned, might not reduce perioperative thromboembolism and can increase bleeding.