BRUISECONTROL2A Randomized Controlled Trial to Investigate Whether a Strategy of Continued Versus Interrupted Novel Oral Anti-coagulant at the Time of Device Surgery, in Patients With Moderate to High Risk of Arterial Thrombo-embolic Events, Leads to a Reduction in the Incidence of Clinically Significant Hematoma

This is a prospective, open-label, randomized trial, with 1:1 randomization to either continued NOAC or interrupted NOAC in patients with non-rheumatic atrial fibrillation or atrial flutter and at moderate to high risk of arterial thrombo-embolic events who require device surgery. All patients in the study will be receiving Dabigatran or Rivaroxaban or Apixaban for at least 5 days prior to enrollment. The peri-operative management of the NOAC the patient is receiving is randomized to Interrupted NOAC or Continued NOAC. Interrupted NOAC arm: Interrupted Dabigatran based on renal function, patients will discontinue Dabigatran 1 day before surgery if GFR > 50 mL/min, and 2 days before surgery if GFR is 30-50 mL/min. Dabigatran will be resumed at the next regular dose time, > or = 24 hours after the end of surgery. Interrupted Rivaroxaban patients will discontinue Rivaroxaban 1 full day before surgery. Rivaroxaban will be resumed at the next regular dose time, > or = 24 hours after the end of surgery. Interrupted Apixaban patients will discontinue Apixaban 1 full day before surgery. Apixaban will be resumed at the next regular dose time, > or = 24 hours after the end of surgery. Continued NOAC arm: -patients will continue their chronic dose of Dabigatran or Rivaroxaban or Apixaban throughout. All patients will have a baseline clinical lab test of serum creatinine or GRF measured. Patients will be seen post-op on the day of their surgery for assessment of the surgical site and each day throughout their hospital stay by a blinded member of the research team. A telephone follow-up will be done on day 3-4 post surgery by an unblinded team member. All patients are seen 1-2 weeks post-op at their first routine post-op device clinic visit, for surgical site assessment by the blinded assessor and to complete Quality of Life questionnaires. Patients will be seen for assessment in the case of any bleeding or development of pocket swelling or hematoma. Patients developing a hematoma will be followed until resolution of the hematoma.