Risk stratification for discontinuation of warfarin therapy with respect to the requirement for heparin bridging
| High risk | Low risk |
|---|---|
| Prosthetic metal heart valve in mitral position | Prosthetic metal heart valve in aortic position |
| Prosthetic heart valve and atrial fibrillation | Xenograft heart valve |
| Atrial fibrillation and mitral stenosis* | Atrial fibrillation without valvular disease |
| <3 months after venous thromboembolism | >3 months after venous thromboembolism Thrombophilia syndromes (discuss with haematologist) |
*Uncertainty exists regarding the thrombotic risk of temporarily discontinuing warfarin in patients with atrial fibrillation and mitral stenosis following the BRIDGE trial,17 but there is insufficient evidence at present to alter the risk category.