Antiplatelet therapy is the cornerstone of secondary prevention of coronary artery disease but potentially increases the risk of bleeding. A process of shared decision-making for perioperative antiplatelet therapy must balance an individual′s thrombotic and bleeding risk, and the potential unintended consequences of delaying non-cardiac surgery. Perioperative management of antiplatelet therapy should be individually tailored based on consensus from multidisciplinary team and patient to minimize both thrombotic and bleeding risks. Current guidelines do not provide consistent recommendations on this topic, and the optimal approach in these patients is yet to be determined.