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Additional "real world" data comes from the ORBIT-AF and Dresden registries. ORBIT-AF ( O utcomes R egistry for B etter I nformed T reatment of A trial F ibrillation) is a community-based registry of outpatients with atrial fibrillation receiving any oral anticoagulant; in this study, 2200 of 7372 individuals (30 percent) had interruption of anticoagulation for a procedure [ 59 ]. Bridging was used in 24 percent of these interruptions, especially in patients with a history of stroke or a mechanical heart valve and/or receiving warfarin ; bleeding events were more common in individuals who received bridging compared with those who did not receive bridging ( versus percent). A composite endpoint that included major bleeding, myocardial infarction, stroke, systemic embolism, hospitalization, or death within 30 days was also higher in those who received bridging (13 versus percent). In the Dresden NOAC registry, over 800 patients who were receiving dabigatran , rivaroxaban , or apixaban for any indication and underwent an invasive procedure had similar rates of major cardiovascular events if they received bridging, no bridging, or no anticoagulant discontinuation [ 60 ]. Bridging was not an independent risk factor for major bleeding; however, individuals undergoing major procedures were more likely to receive bridging and to have major bleeding.

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