Unless contraindicated, an early and liberal postoperative fluid intake should always be encouraged in children. (1B)

In patients who require temporary interruption of a VKA before surgery or a procedure and require normalization of the INR for the surgery or procedure, we recommend stopping VKAs approximately 5 days before surgery over stopping VKAs within a shorter time interval before surgery to allow adequate time for the INR to normalize. (1B)

In patients who have had temporary inter- ruption of a VKA before surgery or a procedure, we recommend resuming VKAs approximately 12 to 24 h (the evening of or the next morning) after surgery and when there is adequate hemostasis over resumption of VKAs closer to surgery. (1C)

In patients who require temporary interruption of a VKA before surgery or a procedure and whose INR is still elevated (ie, >1.5 ) 1 to 2 days before surgery, we suggest administeringlow-dose (ie, 1 to 2 mg) oral vitamin K to normalize the INR instead of not administering vitamin K. (2C)

In patients with a mechanical heart valve or atrial fibrillation or VTE at high risk for thromboembolism, we recommend bridging anticoagulation with therapeutic-dose SC LMWH or IV UFH over no bridging during temporary interruption of VKA therapy (Grade 1C); we suggest therapeutic-dose SC LMWH over IV UFH. (2C) In patients with a mechanical heart valve or atrial fibrillation or VTE at moderate risk for thromboembolism, we suggest bridging anticoagulation with therapeutic-dose SC LMWH,therapeutic-dose IV UFH, or low-dose SC LMWH over no bridging during temporary interruption of VKA therapy (2C); we suggest therapeutic-dose SC LMWH over other management options .. (2C) In patients with a mechanical heart valve or atrial fibrilla-tion or VTE at low risk for thromboembolism,we suggest low-dose SC LMWH or no bridging over bridging with therapeutic-dose SC LMWH or IV UFH. (2C)

In patients who require temporary inter-ruption of VKAs and are to receive bridging anticoagulation, from a cost-containment perspective we recommend the use of SC LMWH administered in an outpatient setting where feasible instead of inpatient administration of IV UFH. (1C)

In patients who are receiving bridging anticoagulation with therapeutic-dose SC LMWH, we recommend administering the last dose of LMWH 24 h before surgery or a procedure over administering LMWH closer to surgery. (1C); for the last preoperative dose of LMWH, we recommend administering approximately half the total daily dose instead of 100% of the total daily dose. (1C) In patients who are receiving bridging anticoagulation with therapeutic-dose IV UFH, we recommend stopping UFH approximately 4 h before surgery over stopping UFH closer to surgery. (1C)

In patients undergoing a minor surgical or other invasive procedure and who are receiving bridging anticoagulation with therapeutic-dose LMWH, we recommend resum- ing this regimen approximately 24h after (eg, the day after) the procedure when there is adequate hemostasis over a shorter (eg, <12h) time interval .. (1C) In patients undergoing major surgery or a high bleeding risk surgery/procedure and for whom postoperative therapeutic-dose LMWH/UFH is planned, we recommend either delaying the initiation of therapeutic-dose LMWH/UFH for 48 to 72 h after surgery when hemostasis is secured, administering low-dose LMWH/UFH after surgery when hemostasis is secured, or completely avoiding LMWH or UFH after surgery over the administration of therapeutic-dose LMWH/UFH in close proximity to surgery. (1C) We recommend considering the anticipated bleeding risk and adequacy of postoperative hemostasis in individual patients to determine the timing of LMWH or UFH resumption after surgery instead of resuming LMWH or UFH at a fixed time after surgery in all patients. (1C)

In patients who are receiving bridging anticoagulation with LMWH, we suggest against the routine use of anti-factor Xa levels to monitor the anticoagulant effect of LMWHs. (2C)

In patients who have had temporary inter-ruption of aspirin therapy because of surgery or a procedure, we suggest resuming aspirin approximately 24 h (or the next morning) after surgery when there is adequate hemostasis instead of resuming aspirin closer to surgery. (2C) In patients who have had temporary interruption of clopidogrel because of surgery or a procedure, we suggest resuming clopidogrel approximately 24 h (or the next morning) after surgery when there is adequate hemostasis instead of resuming clopidogrel closer to surgery. (2C)