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, a left ventricular
assist device (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 lung volume reduction surgery (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.

A related concept is linkage to care, which is a bridge to therapy, such as when community screening
events (for conditions such as high blood pressure or high blood sugar) find new cases of hypertension or
diabetes; recipients are helped to find appropriate care (for example, some have not been to a doctor for
many years and can use help finding a new doctor).

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, 20 (9): 977–
983, doi:10.1089/jpm.2016.0568 (https://doi.org/10.1089%2Fjpm.2016.0568),
PMID 28504892 (https://pubmed.ncbi.nlm.nih.gov/28504892).
2. Prasad, MA; Kulik, LM (2014), "The role of bridge therapy prior to orthotopic liver
transplantation" (http://www.jnccn.org/content/12/8/1183.long), J Natl Compr Canc Netw, 12
(8): 1183–1190, quiz 1191, doi:10.6004/jnccn.2014.0113 (https://doi.org/10.6004%2Fjnccn.2
014.0113), PMID 25099448 (https://pubmed.ncbi.nlm.nih.gov/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, doi:10.1007/BF03256625 (https://doi.org/
10.1007%2FBF03256625), PMID 14720034 (https://pubmed.ncbi.nlm.nih.gov/14720034),
S2CID 30037357 (https://api.semanticscholar.org/CorpusID:30037357).
4. Shigemura, N; et al. (2013), "Lung transplantation after lung volume reduction surgery",
Transplantation, 96 (4): 421–425, doi:10.1097/TP.0b013e31829853ac (https://doi.org/10.109
7%2FTP.0b013e31829853ac), PMID 23736352
(https://pubmed.ncbi.nlm.nih.gov/23736352), S2CID 46364233 (https://api.semanticscholar.o
rg/CorpusID:46364233).
5. Wallinder, A; Pellegrino, V; Fraser, JF; McGiffin, DC (2017), "ECMO as a bridge to non-
transplant cardiac surgery", J Card Surg, 32 (8): 514–521, doi:10.1111/jocs.13172 (https://do
i.org/10.1111%2Fjocs.13172), PMID 28672423 (https://pubmed.ncbi.nlm.nih.gov/28672423),
S2CID 3461110 (https://api.semanticscholar.org/CorpusID:3461110).
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, 52 (1): 14–25,
doi:10.1093/ejcts/ezx088 (https://doi.org/10.1093%2Fejcts%2Fezx088), PMID 28472406 (htt
ps://pubmed.ncbi.nlm.nih.gov/28472406).
7. Morrison, LK; et al. (2017), "Rescue extracorporeal membrane oxygenation therapy in
methamphetamine toxicity", CJEM, 20 (S2): S14–S19, doi:10.1017/cem.2017.356 (https://do
i.org/10.1017%2Fcem.2017.356), PMID 28758605 (https://pubmed.ncbi.nlm.nih.gov/287586
05).
8. Daley, Brian J.; Taylor, Dana; Aycinena Goicolea, Jose Fernando (2016-03-28), Schwer,
William A. (ed.), "Perioperative anticoagulation management" (http://emedicine.medscape.c
om/article/285265-overview), 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 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125758), PMID 25126354
(https://pubmed.ncbi.nlm.nih.gov/25126354).

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