Suggested periprocedural heparin bridging strategies for patients on chronic VKA based on patient thromboembolic and procedural bleed risk. Data from the 9th edition ACCP Guidelines: all grade 2C, except intermediate TE risk.7 *For high-bleed risk procedures: wait a full 48-72 hours before reinitiating postprocedural heparin (LMWH) bridging (especially treatment dose); stepwise increase in postprocedural heparin (LMWH) dose from prophylactic dose first 24-48 hours to intermediate/treatment dose; no postprocedural heparin (LMWH) bridging in very high bleed risk procedures (ie, major neurosurgical or cardiovascular surgeries) but use of mechanical prophylaxis. **Based on individual patient- and procedural-related risk factors for thrombosis and bleeding.
