Anticoagulation interruptus: not without risk.

The need to withhold anticoagulation in patients requiring elective surgery poses a particularly important challenge when the risk of thrombosis and thromboembolism is high. In spite of the increasing use of prosthetic heart valves and the increasing prevalence of atrial fibrillation in the aging population, Kovacs et al1 make the important point in this issue of Circulation that there is a paucity of information in the literature to guide the clinician to optimal care. This observation motivated the design of the prospective study they report. Patients’ anticoagulation therapy was discontinued before surgery. There were 3 reporting phases: preoperative, intraoperative, and postoperative.