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. Postoperative bridging includes administration of an LMWH when VKA is resumed in the postoperative period, with administration of both agents until achievement of a therapeutic INR. The role of bridging has been tested in a randomized trial, Bridging Anticoagulation in Patients who Require Temporary Interruption of Warfarin Ther- apy for an Elective Invasive Procedure or Surgery (BRIDGE), performed in patients on warfarin who were candidates for an invasive procedure (patients with mechanical valves were excluded).94 The risk of thromboembolism after the procedure was similar in patients with and without bridging, but the risk of major bleeding was higher in those who were bridged. Thus, we suggest that preoperative bridging is not required in AF patients treated with warfarin who do not have a particularly high risk of throm- boembolism and who do not have a mechanical valve.  In patients receiving NOACs, bridging is not required, but bridging could be considered in the postoperative phase if the patient cannot take oral medications for a prolonged period. Recommendations 57. In AF patients taking warfarin without high risk of thromboembolism or do not have a mechanical valve, we suggest preoperative management without bridging (Weak recommendation, low quality evidence). 58. In AF patients on antithrombotic prophylaxis with warfarin with a high risk of thromboembolism or with a mechanical valve, we suggest preoperative management with bridging (Weak recommendation, low quality evidence). 59. In AF patients on antithrombotic prophylaxis with an NOAC, we suggest preoperative management without bridging (Weak recommendation, low quality evidence). 