12. We suggest that interruption of anticoagulant therapy, particularly for VKAs, in a patient with AF/AFL is not necessary for most procedures with a low risk of bleeding, such as cardiac device implantation (pacemaker or implantable defibrillator), and most dental procedures (Table 1) (Conditional Recommendation, Moderate-Quality Evidence).
13. When a decision to interrupt warfarin therapy for an invasive procedure has been made for a patient with AF/AFL, we suggest that bridging therapy with LMWH or UFH be instituted when the INR is below therapeutic level only in patients at high risk of thromboembolic events (CHADS2, score  4, mechanical heart valve, stroke/transient ischemic attack within 3 months, rheumatic heart disease) (Conditional Recommendation, Low-Quality Evidence).
14. We recommend no bridging (LMWH or UFH) for NVAF patients receiving NOACs who undergo elective surgery or invasive procedures requiring interruption of anticoagulation (Strong Recommendation, Moderate-Quality Evidence).

Practical tip. Duration of preprocedural interruption of NOACs should be adjusted according to renal function (see Part 11, Recommendations 6 and 7 of the Supplementary Material). The Thrombosis Canada Perioperative Anticoagulant Management Algorithm is a helpful tool to aid decisions regarding periprocedural anticoagulation (http://thrombosiscanada.ca/?page_ id¼502&calc¼perioperativeAnticoagulantAlgorithm).