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©2013 UpToDate ® Print Email Recommendations for preoperative and postoperative anticoagulation in patients on oral anticoagulation therapy Indication Before surgery Aftersurgery Venous thromboembolism Within first month IV heparin or SQ LMWH IV heparin or SQ LMWH Second/third month No change* IV heparin or SQ LMWH ≥3months No change* SQ heparin or LWMH Arterial thromboembolism Recent, within one month IV heparin or SQ LMWH IV heparin or SQ LMWH Prophylaxis (non valvular AF,mechanical valves) No change* Resume oral anticoagulation• NOTE: Warfarin should be withheld to allow the INR to fall spontaneously to 1.5 to 2 before surgery is performed. LMWH: low molecular weight heparin. * If the patient is hospitalized, subcutaneous (SQ) heparin or LMWH should be administered, but hospitalization is not recommended solely for this purpose. • Can use SQ heparin or SQ LMWH if the surgery carries a high risk of postoperative thromboembolism.