Use of NOACs in the Peri-Operative Management of Patients with Atrial Fibrillation: To Stop, Bridge or Continue?

Over the last decade, the availability of non-vitamin K antago- nist oral anticoagulants (NOACs) has significantly changed the daily clinical practice in managing thromboembolic risk in patients with atrial fibrillation (AF).1 Guidelines for AF man- agement have established that NOACs are the preferred treat- ment for the majority of AF patients;2 however, recent data from ‘real-life’ registries clearly show that a significant pro- portion of patients are still treated with vitamin K antago- nists.3–8 Nevertheless, the role of NOACs still seems to be debated in some specific circumstances, such as their role in the peri-operative management of patients with AF, in relation to interruption or continuation of anticoagulation.