Chapter 3 44 Furthermore, patients used different NOACs in the present study. The limited number of NOAC patients precluded further subanalysis for the different NOACs. 6. Conclusions In patients undergoing catheter ablation of AF, a minimally interrupted NOAC strategy was associated with fewer clinically relevant non-major bleeding compared with uninterrupted VKA. The risk of major bleeding and thromboembolic events was similar between both strategies. Our study reinforces the safety and efficacy of a minimally interrupted NOAC strategy as periprocedural anticoagulant in patients undergoing catheter ablation of AF. 7. Compliance with ethical standards The Medical Ethics Committee of the Erasmus Medical Center reviewed the study (MEC-2015-073), and this retrospective study was not subjected to the Dutch Medical Research Involving Human Subjects Act. The study was carried out according to the ethical principles for medical research involving human subjects established by Declaration of Helsinki, protecting the privacy of all the participants and the confidentiality of their personal information. References 1. Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R, et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the role of coumadin in preventing thromboembolism in atrial fibrillation (AF) patients undergoing catheter ablation (COMPARE) randomized trial. Circulation. 2014;129(25):2638–44. 2. Jackson LR 2nd, Becker RC. Novel oral anticoagulants: pharmacology, coagulation measures, and considerations for reversal. JThromb Thrombolysis. 2014;37(3):380–91. 3. Di Biase L, Lakkireddy D, Trivedi C, Deneke T, Martinek M, Mohanty S, et al. Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: results from a multicenter study. Heart Rhythm. 2015;12(6):1162–8. 4. Aryal MR, Ukaigwe A, Pandit A, Karmacharya P, Pradhan R, Mainali NR, et al. Meta-analysis of efficacy and safety of rivaroxaban compared with warfarin or dabigatran in patients undergoing catheter ablation for atrial fibrillation. Am J Cardiol. 2014;114(4):577–82. 5. Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation.N Engl JMed. 2017;376(17):1627–36. 6. Cappato R,Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015;36(28):1805–11. 7. Hohnloser SH, Camm AJ. Safety and efficacy of dabigatran etexilate during catheter ablation of atrial fibrillation: a metaanalysis of the literature. Europace. 2013;15(10):1407–11.
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