ABC | Volume 114, Nº3, March 2020

Original Article Silva et al. AF ablation with rivaroxaban Arq Bras Cardiol. 2020; 114(3):435-442 Figure 3 – Cerebrovascular accident (CVA) - Magnetic Resonance Imaging of a Patient with CVA – Hyperintense lesion on Flair sequence in the left central gyrus topography, compatible with acute ischemia. Figure 4 – Results: Secondary outcomes related to anticoagulation level monitoring. A - Preoperative International Normalized Ratio (INR); B - Baseline ACT (activated clotting time), measured after the first venipuncture; C – Mean dose of intravenous heparin used throughout the procedure; D – Mean ACT during the procedure. 3 15000 10000 5000 400 300 200 100 0 0 2 1 0 RIV INR VRF RIV VRF RIV VRF RIV VRF 150 100 50 0 Baseline ACT {seg} Mean ACT Dose de Heparona {UI} p < 0.0001 p < 0.0001 p = 0.49 p = 0.34 A C B D the results of this study. Rivaroxaban was compared to warfarin, this time without interruption of DOAC, in a prospective, multicenter study involving 642 patients. Patients (CHA 2 DS 2 -VASC=2/paroxysmal AF = 50%) were given the last dose of rivaroxaban the night before the procedure, ensuring that it was performed within the therapeutic window of the drug, and there was no significant difference regarding embolic and hemorrhagic complications. 15 DOAC in AF ablationwere tested inmulticenter and randomized studies. 6,16-18 In the Venture-AF Trial, the first randomized trial comparing uninterrupted DOAC (rivaroxaban) to warfarin in AF ablation, the rate of TE or hemorrhagic events was low, similar between the groups; 6 in the RE-CIRCUIT Trial, dabigatran use resulted in fewer bleeding complications than warfarin (1.6%  vs. 6.9%; p < 0.001). 16 In the AXAFA-AFNET 5, 674 patients were randomized to ablation under continuous use 439