Both continuation of novel oral anticoagulant (NOAC) and interruption of NOAC were associated with similar, very low rates of device pocket hematoma in patients with atrial fibrillation (AFib), according to results of the BRUISE CONTROL-2 trial presented at American Heart Association’s Scientific Sessions 2017.

David H. Birnie, MD, et al., randomly assigned 662 patients with AFib treated with dabigatran, rivaroxaban or apixaban, with a CHA2DS2VASC score >=2, to continued DOAC (n=328) or interrupted DOAC (n=334).

The primary outcome was clinically significant hematoma, defined as prolongation of hospitalization and/or interruption of anticoagulation and/or re-operation to evacuate. Results showed that both strategies had very low rates of device pocket hematoma, and that there were "no significant between-group differences in any variables, except for intrapocket administration of prohemostatic agent and application of dressing postoperatively (both P=0.035)."

The authors conclude that "operating with continued DOAC should not be considered specifically as a strategy to reduce hematoma rate," but that "either strategy may be reasonable depending on clinical scenario."

"The trial gives clinicians the leeway to discontinue the agents when there is greater fear for bleeding but equally allows continuation of the anticoagulant among patients where the thrombosis side of the equation seems paramount," commented Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org.