DOACs in pacemaker or defibrillator surgery 81 4.3. Study limitations This was a retrospective observational single-center study with its inherent limitations. Selection bias may play a role as DOAC are less often used in patients with renal dysfunction which is a known risk factor for pocket hematoma. Furthermore, we were unable to statistically correct for differences in baseline variables between groups due to the low number of events. 5. Conclusions In patients with AF undergoing an elective CIED procedure, the risk of a clinically significant pocket hematoma and a systemic thromboembolic event is comparably low when using either continued VKA or interrupted DOAC. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgements None. References 1. Hindricks G, Potpara T, Dagres N, et al. Group ESCSD., 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC, Eur Heart J. 2021;42:373-498. 2. Steffel J, Collins R, Antz M, et al. Field M. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation, Europace. 2021. 3. Birnie DH, Healey JS, Wells GA, et al. Essebag V., Continued vs. interrupted direct oral anticoagulants at the time of device surgery, in patients with moderate to high risk of arterial thromboembolic events (BRUISE CONTROL-2), Eur Heart J. 2018;39:3973-3979. 4. D.H. Birnie, J.S. Healey, G.A. Wells, A. Verma, A.S. Tang, A.D. Krahn, C.S. Simpson, F. AyalaParedes, B. Coutu, T.L.L. Leiria, V. Essebag, Pacemaker or defibrillator surgery without interruption of anticoagulation, N Engl J Med., 368 (22) (2013), pp. 2084-2093 5. S. Ferretto, G. Mattesi, F. Migliore, A. Susana, M. De Lazzari, S. Iliceto, L. Leoni, E. Bertaglia, Clinical predictors of pocket hematoma after cardiac device implantation and replacement, J Cardiovasc Med (Hagerstown), 21 (2) (2020), pp. 123-127 6. Burri H, Starck C, Auricchio A, et al. Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable 5
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