The management of patients who require temporary interruption of warfarin therapy because of elective surgery or another invasive procedures is clinically important because of the increasing prevalence of patients who are receiving warfarin and the availability of low-molecular-weight heparins, which facilitate out-of-hospital perioperative anticoagulation. The two main issues that need to be considered in perioperative anticoagulant management is the patient's risk of a thromboembolic event when warfarin therapy is interrupted and the risk of bleeding that is associated with the surgery or procedure. An assessment of these factors will determine the optimal perioperative anticoagulant management approach. The overall objective of this review is to provide a practical approach relating to perioperative anticoagulation which can be used in everyday clinical practice.