Day(s) before or after surgery	Medication
	Direct oral anticoagulants	Antiplatelets		Vitamin K antagonists*
		P2Y12 inhibitors	Aspirin
−7 to −10	NA	Stop prasugrel (Effient)	Continuing aspirin through surgery is recommended, otherwise stop at < 7 days prior	NA
−5	NA	Stop clopidogrel		Stop vitamin K antagonist
−4	Stop dabigatran (Pradaxa) if bleeding risk is high and if glomerular filtration rate < 50 mL per min per 1.73 m2 (0.83 mL per s per m2)	Stop ticagrelor (Brilinta; 3 to 5 days)		No warfarin
−3	Stop dabigatran if bleeding risk is low or moderate and glomerular filtration rate is < 50 mL per min per 1.73 m2	Stop ticagrelor; 3 to 5 days)		Start low-molecular-weight heparin bridging if necessary No warfarin
−2	Stop direct oral anticoagulant if high bleeding risk and normal glomerular filtration rate	No prasugrel, clopidogrel, ticagrelor		Continue low-molecular-weight heparin No warfarin
−1	Stop direct oral anticoagulant if low or moderate bleeding risk and normal glomerular filtration rate	No prasugrel, clopidogrel, ticagrelor		If bridging, give half the daily dosage of low-molecular-weight heparin 24 hours before surgery, then stop low-molecular-weight heparin No warfarin
Surgery	No direct oral anticoagulants	No prasugrel, clopidogrel, ticagrelor		No low-molecular-weight heparin No warfarin
+1	Restart direct oral anticoagulant if low or moderate bleeding risk	Restart all		Restart vitamin K antagonist
+2	Restart direct oral anticoagulant if high bleeding risk	NA		Restart low-molecular-weight heparin bridging for low- to moderate-risk bleeding until international normalized ratio at goal
+3	NA	NA		Restart low-molecular-weight heparin bridging for high bleeding risk until international normalized ratio at goal