We recommend that in patients taking warfarin for whom perioperative anticoagulation is deemed necessary, continued warfarin is recommended over the use of heparin-based bridging.
(Strong Recommendation, Moderate-Quality Evidence)

Values and preferences: This recommendation places great value on safely preventing perioperative bleeding and the quality of the evidence.

Practical tip: PerioperativeOAC is usually deemed necessary in patients at high risk of thromboembolism (CHADS₂ 3 or > 5% annual risk, refer to Use of Antithrombotic Agents Periprocedurally section for details). No data are presently available on the use of novel oral anticoagulants in this population; interruption of these agents should be of short duration in patients at high risk of thromboembolism, but renal function, procedural risk, and complexity of the procedure might need to be considered in these situations. The rapidity of onset and offset make these more facile to control periprocedurally. Discontinuation of OAC in patients at lower risk of thromboembolism should be considered to minimize the risk of bleeding.