Perspective:

Uninterrupted VKA has become a standard of therapy to prevent stroke while minimizing bleeding due to the use of bridging heparin in VKA-treated patients undergoing catheter ablation for AF. Now that DOAC therapy is first line for many patients with AF, multiple randomized trials have compared uninterrupted DOAC therapy to uninterrupted VKA therapy to explore safety outcomes. Most of these have been underpowered to detect important differences in major bleeding. This meta-analysis provides evidence that, in general, a strategy of uninterrupted DOAC therapy is associated with less major bleeding risk than uninterrupted VKA therapy. However, the CI for thromboembolic events is broad enough that claims of ‘similar outcomes’ cannot be fully assessed at this time. Nonetheless, in patients taking DOAC therapy for stroke prevention in AF, it is reasonable to continue DOAC therapy uninterrupted during their catheter ablation procedure rather than switching to warfarin or a heparin-based bridging protocol.