Barker, Timothy HughThomas; LisaBhat , AdityaKaur, Jaspreet2025-03-282025-03-282024https://hdl.handle.net/2440/144052Introduction: Atrial fibrillation (AF) is the most commonly diagnosed clinical arrhythmia and a significant cause of cardioembolic events, necessitating chronic oral anticoagulation in most patients. The efficacy of heparin bridging during temporary interruptions of oral anticoagulants compared to no bridging in the perioperative setting remains unclear. This systematic review aims to investigate the efficacy of withholding perioperative anticoagulation bridging in patients with AF, specifically focusing on thromboembolic events and bleeding incidents. Inclusion Criteria: This thesis details the conduct of a systematic review. We considered studies comparing adults aged eighteen and above diagnosed with AF and CHA2DS2-VASc score of one or more, undergoing elective invasive procedures, who had oral anticoagulants temporarily withheld with or without heparin bridging. Participants were excluded if they had an alternative reason for anticoagulation or were admitted for emergent surgery. The outcomes included stroke, transient ishaemic attack, systemic embolism, major bleeding events, non-major bleeding events, length of hospital stay, and all-cause mortality. Methods: In this systematic review, electronic databases including Medline, Embase, Cinahl, and CENTRAL were searched for relevant randomized and non-randomized trials from inception until the present. Citations were reviewed by title and abstract, followed by full-text screening by two independent reviewers. The risk of bias was assessed using the appropriate critical appraisal instruments from JBI, and data were extracted with a modified extraction tool. Study results were synthesized using random-effects meta-analysis, where possible, and presented in forest plots. Heterogeneity was tested using standard Chi-square and I² tests. The overall certainty of evidence was evaluated using the GRADE approach. Results: This review included three studies comprising a total of 4738 patients. The analysis showed no statistically significant differences in stroke (RR 0.73, 95% CI: 0.32 to 1.69), systemic embolism (RR 1.35, 95% CI: 0.47 to 3.46), transient ischemic attack (RR 4.87, 95% CI: 0.23 to 101.4), or all-cause mortality (RR 1.01, 95% CI: 0.50 to 2.04) between the bridging and no-bridging groups. Major bleeding was lower in the no-bridging group (RR 0.36, 95% CI: 0.27 to 0.47), as was non-major bleeding (RR 0.61, 95% CI: 0.51 to 0.74). Length of stay was not assessed as an outcome in the included studies. Conclusion: This systematic review demonstrated that withholding perioperative heparin bridging in patients with AF and CHA2DS2-VASc score of one or more did not result in statistically significant differences in the incidence of stroke, systemic embolism, transient ischemic attack, or all-cause mortality compared to those who received bridging. However, patients who were not bridged had significantly lower rates of both major and non-major bleeding. These findings suggest that perioperative heparin bridging may not provide additional benefits and may increase bleeding risks, particularly in patients with low thromboembolic risk. Further research is needed to confirm these findings in patients with higher CHA2DS2-VASc scores and to optimize perioperative anticoagulation management strategies.enAnticoagulationatrial fibrillationbridgingheparinperioperativeThesis