Substantial new evidence has emerged since the 2012 iteration of these guidelines, especially to inform best practices for the perioperative management of patients who are receiving a VKA and may require heparin bridging, for the perioperative management of patients who are receiving a DOAC, and for patients who are receiving one or more antiplatelet drugs.

Despite this new knowledge, uncertainty remains as to best practices for the majority of perioperative management questions.

A multidisciplinary panel generated 43 guideline recommendations for the perioperative management of VKAs, heparin bridging, DOACs, and antiplatelet drugs of which 2 are strong recommendations: against the use of heparin bridging in patients with atrial fibrillation; and continuation of VKA therapy in patients having a pacemaker or internal cardiac defibrillator (ICD) implantation.

There are separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatological, ophthalmological, pacemaker/ICD implantation, and gastrointestinal (endoscopic) procedures.

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