This chapter provides a practical guide for hospitalists on perioperative cardiac risk assessment and anticoagulation management to optimize patient safety during surgery. It outlines a stepwise approach to cardiac evaluation, incorporating clinical risk indices, functional capacity assessment, and targeted diagnostic testing such as ECG, echocardiography, and stress testing. This chapter emphasizes stratifying patients based on cardiovascular risk and the urgency and invasiveness of surgery to guide decision-making. Special focus is given to managing patients on chronic anticoagulation or antiplatelet therapy, balancing thromboembolic risks against bleeding complications, and strategies for perioperative bridging or temporary interruption. It reviews guidelines for common scenarios, including atrial fibrillation, mechanical heart valves, and venous thromboembolism history. Coordination with cardiology, anesthesia, and surgical teams is highlighted to ensure individualized planning. This chapter equips hospitalists with evidence-based tools to reduce perioperative cardiac events and optimize anticoagulation strategies in diverse patient populations.