If the bleeding risk is substantial, then interruption of anticoagulation prior to the procedure intervention is needed to minimize the hemorrhagic risk, both in the intra-operative and immediate postoperative phase.  Estimation of patient thromboembolic risk. Calcu- late the CHA2DS2-VASc score (low risk if 0 or 1) but an additional transient increase in risk has to be considered in case of recent stroke or recent pulmo- nary embolism.  Planning of the timing of anticoagulation inter- ruption. The timing of interruption is strictly dependent on the speci c anticoagulant the patient is receiving and CrCl. Important differences exist be- tween the management of patients treated with VKA The effect of warfarin can be monitored through INR; however, no standard labo- ratory test exists to measure the effect of NOACs. Discontinuation of warfarin is usually instituted 5 days before an elective surgical intervention, with INR checked the day before surgery, with the usual indication that surgery can be regularly planned if the INR is # 1.4 to 1.5 the day before surgery or the same day of surgery.465 For NOACs, the planning of interruption and resumption of therapy for surgical interventions/procedures is dependent on the type of procedure/intervention, the speci c agent used, and renal function, estimated by creatine clearance (using the Cockroft-Gault equation). In case of urgent sur- gery, reversal of anticoagulation or speci c measures may be required.205,466  Evaluation of the need for bridging. Pre-operative bridging can be considered in patients receiving VKA who are at particularly high risk of thromboembolism (eg, recent stroke, mechanical heart valve).465 In these cases, LMWH at therapeutic doses is usually pre- scribed starting 3 days before the procedure/inter- vention. 