Impact of Perioperative Bridging Therapy on Thrombotic and Bleeding Events Among Patients Undergoing Major Surgical Procedures

ABSTRACT Background The use of perioperative bridging therapy remains a topic of debate due to its associated risks and benefits. Therefore, we sought to characterize the association of bridging therapy with thrombotic and bleeding events following a major surgical procedure. Method Patients who underwent surgical procedures between 2022 and 2024 were identified using Epic Cosmos database in this retrospective cohort study. Bridging therapy (BT) was defined by the receipt of low molecular weight heparin (LMWH) or unfractionated heparin within 5 days before surgery. Thrombotic and bleeding events within 30‐day following surgery were examined using entropy balancing (EB) and multivariable regression models. Results Among 36,699 patients (i.e., pneumonectomy: n = 5829, 15.9%, esophagectomy: n = 434, 1.2%, gastrectomy: 4574, 12.5%, pancreatectomy: n = 983, 2.7%, hepatectomy: n = 946, 2.6%, biliary resection: n = 7034, 19.2%, and colectomy: n = 16,899, 46.0%), most were male ( n = 19,418, 52.9%) with a mean age of 70 years (standard deviation: ± 13 years); 59.9% ( n = 21,831) of patients received bridging therapy before a major surgical procedure. Following surgery, 4.6% (1673) of patients had VTE, 1.7% ( n = 625) had CVA, and 12.3% ( n = 4532) had bleeding. Following EB weighting, patients who received bridging therapy had 16% lower odds of CVA (OR: 0.84, 95% CI 0.71–0.99) and 12% lower odds of VTE (OR: 0.88, 95% CI 0.80–0.97); there was no difference in incidence of major bleeding events (OR: 0.97, 95% CI 0.91–1.03). Conclusion Roughly one in two patients undergoing surgery received bridging therapy. Bridging therapy was associated with reduced risk of thrombotic complications and no increase in major bleeding events.