We suggest that patients with AF or AFL who are receiving aspirin, clopidogrel, or OAC and are scheduled for a surgical or diagnostic procedure carrying a risk of major bleeding be stratified by their risk of stroke:<br /><ul><li>If there is a <i>very low to moderate risk of stroke</i> (CHADS<sub>2</sub> &le;2), patients should have their antithrombotic agent discontinued before the procedure (aspirin or clopidogrel for 7-10 days, warfarin for 5 days if the INR was in the range of 2-3, and dabigatran for 2 days). Once postprocedure hemo- stasis is established (about 24 hours), the antithrombotic therapy should be reinstated. (Recommendation Conditional, Quality Low)</li></ul><br /><br />If there is a <i>particularly high risk of stroke</i> (eg, mechanical valve, recent stroke or TIA, rheumatic valve disease, CHADS<sub>2</sub> &ge;3) or of other thromboembolism (eg, Fontan procedure), further consideration should be given to the risk of major bleeding from the procedure:<br /><ul><li>If there is an <i>acceptable perioperative bleeding risk</i> (ie, risk of stroke outweighs risk of bleeding), patients should have OAC therapy continued perioperatively or have their OAC discontinued before the procedure and be bridged with LMWH or UFH perioperatively. (Recommendation Conditional, Quality Low)</li><li>If there is a <i>substantial risk of major and potentially problematic bleeding</i> (ie, risk of bleeding and risk of stroke are both substantial), patients should have their OAC discontinued before the procedure, with LMWH or UFH bridging until 12 to 24 hours preprocedure. Once postprocedure hemostasis is established (about 24 hours), the OAC should be reinstated with LMWH or UFH bridging. (Recommendation Conditional, Quality Low)</li></ul>