Bridge therapy

Bridge therapy is therapy intended, in transportation metaphor, to serve as a figurative bridge to another stage of therapy or health, carrying a patient past a challenging period of some kind. There are various types of bridge therapy, such as bridge to transplant, bridge to candidacy, bridge to decision, bridge to recovery, and anticoagulation bridge (such as heparin bridge). Bridge therapy exists in contrast to destination therapy, which is the figurative destination rather than a bridge to something else.

• Bridge to transplant: Such therapy preserves someone's health well enough and long enough that they can make it to organ transplant, still being eligible for transplant after spending time waiting for an organ to become available. For example, LVAD often serves as a bridge to heart transplant,[1] locoregional therapy (such as radiofrequency ablation) for hepatocellular carcinoma can serve as a bridge to liver transplant,[2] and LVRS can serve as a bridge to lung transplant.[3][4]
• Bridge to candidacy: A patient was too sick to be a candidate for a certain therapy, but the bridge carries them to a state of being eligible; for example, ECMO as a bridge to nontransplant cardiac surgery.[5]
• Bridge to decision: A decision will soon be made about what to do next (that is, which definitive therapy will come soon), but first the patient needs a bridge to support them until that decision; for example, short-term mechanical circulatory support as a bridge to durable left ventricular assist device implant in refractory cardiogenic shock.[6]
• Bridge to recovery: A recovery is likely, but first support is needed to carry someone through a tough time; for example, ECMO in methamphetamine toxicity, which can be viewed as both rescue therapy and bridge to recovery.[7]
• Anticoagulation bridge: Temporary anticoagulation, such as with heparin, is used during a perioperative period when a patient's regular anticoagulant therapy, such as with warfarin, is suspended;[8][9] the goal is to prevent excess risk of severe bleeding during or after surgery. The heparin bridge provides some anticoagulant effect (to prevent thrombosis from warfarin withdrawal) but not as much as would make severe bleeding likely.

References

1. Nakagawa, S; et al. (2017), "Palliative care interventions before left ventricular assist device implantation in both bridge to transplant and destination therapy", J Palliat Med, doi:10.1089/jpm.2016.0568, PMID 28504892.
2. Prasad, MA; Kulik, LM (2014), "The role of bridge therapy prior to orthotopic liver transplantation", J Natl Compr Canc Netw, 12 (8): 1183–1190, quiz 1191, PMID 25099448.
3. Cordova, FC; Criner, GJ (2002), "Lung volume reduction surgery as a bridge to lung transplantation", Am J Respir Med, 1 (5): 313–324, PMID 14720034.
4. Shigemura, N; et al. (2013), "Lung transplantation after lung volume reduction surgery", Transplantation, 96 (4): 421–425, doi:10.1097/TP.0b013e31829853ac, PMID 23736352.
5. Wallinder, A; Pellegrino, V; Fraser, JF; McGiffin, DC (2017), "ECMO as a bridge to non-transplant cardiac surgery", J Card Surg, doi:10.1111/jocs.13172, PMID 28672423.
6. den Uil, CA; et al. (2017), "Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis", Eur J Cardiothorac Surg, doi:10.1093/ejcts/ezx088, PMID 28472406.
7. Morrison, LK; et al. (2017), "Rescue extracorporeal membrane oxygenation therapy in methamphetamine toxicity", CJEM, doi:10.1017/cem.2017.356, PMID 28758605.
8. Daley, Brian J.; Taylor, Dana; Aycinena Goicolea, Jose Fernando (2016-03-28), Schwer, William A. (ed.), "Perioperative anticoagulation management", Medscape, retrieved 2017-08-11.
9. Baser, Onur; Supina, Dylan; Sengupta, Nishan; Wang, Li (2011), "Anticoagulation bridging therapy patterns in patients undergoing total hip or total knee replacement in a US health plan: real-world observations and implications", Am Health Drug Benefits, 4 (4): 240–248, PMC 4125758, PMID 25126354.