In patients undergoing a minor surgical or other invasive procedure and who are receiving bridging anticoagulation with therapeutic-dose LMWH, we recommend resum- ing this regimen approximately 24h after (eg, the day after) the procedure when there is adequate hemostasis over a shorter (eg, <12h) time interval .. (1C) In patients undergoing major surgery or a high bleeding risk surgery/procedure and for whom postoperative therapeutic-dose LMWH/UFH is planned, we recommend either delaying the initiation of therapeutic-dose LMWH/UFH for 48 to 72 h after surgery when hemostasis is secured, administering low-dose LMWH/UFH after surgery when hemostasis is secured, or completely avoiding LMWH or UFH after surgery over the administration of therapeutic-dose LMWH/UFH in close proximity to surgery. (1C) We recommend considering the anticipated bleeding risk and adequacy of postoperative hemostasis in individual patients to determine the timing of LMWH or UFH resumption after surgery instead of resuming LMWH or UFH at a fixed time after surgery in all patients. (1C)

In patients who are receiving bridging anticoagulation with LMWH, we suggest against the routine use of anti-factor Xa levels to monitor the anticoagulant effect of LMWHs. (2C)

In patients who have had temporary inter-ruption of aspirin therapy because of surgery or a procedure, we suggest resuming aspirin approximately 24 h (or the next morning) after surgery when there is adequate hemostasis instead of resuming aspirin closer to surgery. (2C) In patients who have had temporary interruption of clopidogrel because of surgery or a procedure, we suggest resuming clopidogrel approximately 24 h (or the next morning) after surgery when there is adequate hemostasis instead of resuming clopidogrel closer to surgery. (2C)

In patients who are receiving antiplatelet drugs, we suggest against the routine use of platelet function assays to monitor the antithrombotic effect of aspirin or clopidogrel. (2C)

For patients who are not at high risk for cardiac events, we recommend interruption of antiplatelet drugs .. (1C) For patients at high risk of cardiac events (exclusive of coronary stents) scheduled for noncardiac surgery,we suggest continuing aspirin up to and beyond the time of surgery (Grade 2C); if patients arereceiving clopidogrel, we suggest interrupting clopidogrel at least 5 days and, preferably,within 10 days prior to surgery .. (2C) In patients scheduled for CABG, we recommend continuing aspirin up to and beyond the time of CABG (Grade 1 C); if aspirin is interrupted, we recommend it be reinitiated between 6 hand 48h after CABG .. (1C) In patients scheduled for CABG, we recommend interrupting clopidogrel at least 5 days and, preferably, 10days prior to surgery .. (1C) In patients scheduled for PCI, we suggest continuing aspirin up to and beyond the time of the procedure;if clopidogrel is interrupted prior to PCI, we suggest resuming clopidogrel after PCI with a loading dose of 300 to 600 mg. (2C)

In patients with a bare metal coronary stent who require surgery within 6 weeks of stent placement, we recommend continuing aspirin and clopidogrel in the perioperative period .. (1C) In patients with a drug-eluting coronary stent who require surgery within 12 months of stent placement, we recommend continuing aspirin and clopidogrel in the perioperative period .. (1C) In patients with a coronary stent who have interruption of antiplatelet therapy before surgery, we suggest against the routine use of bridging therapy with UFH, LMWH, direct thrombin inhibitors, or glycoprotein IIb/IIIa inhibitors. (2C)

In patients who are undergoing minor dental procedures and are receiving VKAs, we recommend continuing VKAs around the time of the procedure and coadministering an oral prohemostatic agent. (1B) In patients who are undergoing minor dental procedures and are receiving aspirin, we recommend continuing aspirin around the time of the procedure. (1C)

In patients who are undergoing cataract removal and are receiving VKAs, we recommend continuing VKAs around the time of the procedure. (1C) In patients who are undergoing cataract removal and are receiving aspirin, we recommend continuing aspirin around the time of the procedure. (1C)

In patients who are receiving VKAs and require reversal of the anticoagulant effect for an urgent surgical or other invasive procedure, we recommend treatment with low-dose (2.5 to 5.0mg) IV or oral vitamin K.. (1C) For more immediate reversal of the anticoagulant effect, we suggest treatment with fresh-frozen plasma or another prothrombin concentrate in addition to low-dose IV or oral vitamin K. (2C)

For patients receiving aspirin, clopi-ogrel, or both, are undergoing surgery, and have excessive or life-threatening perioperative bleeding, we suggest transfusion of platelets or administration of other prohemostatic agents. (2C)