American College of Cardiology recommendations: Perioperative anticoagulation in patients with atrial fibrillation
| Thromboembolic risk category | Bleeding risk category | Recommendation |
|---|---|---|
| Low (≤5%/year, CHA2DSr-VASc ≤ 4)a | All levels of bleeding | Interrupt vitamin K antagonists without bridging |
| Moderate (5%-10%/year, CHA2DS2-VASc 5 or 6) | High procedural bleeding risk | Interrupt vitamin K antagonists without bridging |
| No significant bleeding risk without history of stroke, transient ischemic attack, or systemic embolism | Interrupt vitamin K antagonists without bridging | |
| No significant bleeding risk with history of stroke, transient ischemic attack, or systemic embolism | Consider bridging | |
| High (> 10%/year, CHA2DS2-VASC≥7) | All levels of bleeding risk | Should generally be considered for bridging |
| High bleeding risk | Apply clinical judgment |
↵a CHA2DS2-VASc = 1 point for congestive heart failure, hypertension, age 65 to 75, diabetes, vascular disease, or female sex; 2 points for history of either stroke or transient ischemic attack or thromboembolism, and/or age ≥ 75.
Based on information in reference 25.