Perioperative Management of Oral Anticoagulation in Patients with Venous Thromboembolism.

Perioperative management of anticoagulation for patients with history of venous thromboembolism (VTE) is based on the patient's individual recurrent VTE risk and procedural bleeding risk. The American College of Chest Physicians (ACCP) guidelines can help in estimating VTE recurrence risk. For warfarin, holding 5 days prior to a procedure, and restarting the night of or morning after is suggested. For direct oral anticoagulants, holding for 1 calendar day (as opposed to 24 hours) in low-to-moderate bleeding risk procedures, and 2 days for high bleeding risk procedures has been shown to be safe and is supported by the ACCP guidelines.