When you start a patient on Warfarin (i.e after a PE); there will be an overlap of administration of Warfarin and LMWH/ UFH for typically 5 days with a goal INR of 2-3. This is referred to as “Bridging“.
WHY? Warfarin introduces a temporary hypercoagulable stage during the first 36 hours. Protein C and Protein S (anti-coagulation factors) are vitamin K-dependent plasma proteins. Levels of these anti-coagulation factors drop faster than the pro-coagulation factors (10,9,7,2) we attempt to block with Warfarin. Therefore, bridging is used to counteract this transient pro-clotting state.
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