Controversies and Advances in Perioperative Bridging with Low Molecular Weight Heparin for Noncardiac Surgery in Patients on Dual Antiplatelet Therapy After PCI

The use of low molecular weight heparin(LMWH) as a bridging therapy for dual antiplatelet therapy in patients undergoing non-cardiac surgery after percutaneous coronary intervention(PCI) remains controversial. This review summarizes guidelines, clinical trials, and mechanistic studies from domestic and international sources to analyze the role of LMWH in balancing thrombotic and bleeding risks. Current international guidelines generally do not recommend LMWH for bridging antiplatelet therapy, while Chinese expert consensus documents reflect divergent opinions on this issue. Clinical studies indicate that the benefits and risks of LMWH in the perioperative period may be significantly associated with the time interval between PCI and non-cardiac surgery. Mechanistic evidence suggests that in the early post-PCI phase, LMWH may inadequately suppress thrombosis driven by intense platelet aggregation when stent endothelialization is incomplete. Therefore, individualized decision-making based on the post-PCI time interval, thrombotic risk, and bleeding risk is recommended. During high thrombotic risk periods, short-acting antiplatelet agents should be prioritized to maintain platelet inhibition, and LMWH as a bridging strategy in this context should be considered with caution.