A multicentre, single-blind trial published in the American Heart Journal showed that there is no difference between the incidence of clinically significant hematoma in individuals with atrial fibrillation who undergo pacemaker or defibrillator surgery, irrespective of whether their direct oral anticoagulants (DOACs) are continued or interrupted peri-operatively. In this trial, patients with atrial fibrillation and CHA₂DS₂-VASc score ≥ 2 treated with dabigatran, rivaroxaban, or apixaban were randomly allocated to receive either continuous or interrupted doses of their DOACs at the time of pacemaker or defibrillator surgery. It was also observed that the incidence of non-clinically significant hematoma was also comparable between these groups (3.4% vs 3%). The rates of secondary outcomes such as cardiac tamponade, stroke, and all-cause mortality were also comparable but low in number.