FOLLOWING catheter ablation (CA) for atrial fibrillation (AF), the decision to discontinue oral anticoagulants (OACs) remains controversial, as there is no clear consensus on the optimal management strategy. A recent study aimed to evaluate the impact of OAC discontinuation on thromboembolic and major bleeding events, as well as all-cause mortality, in patients after successful CA. It also sought to identify characteristics that could influence the prognosis following OAC cessation. The key finding of the study was that OAC discontinuation was associated with increased thromboembolic risk, but lower bleeding risk, highlighting the importance of patient-specific factors when considering OAC management post-ablation.
The retrospective cohort study included 1821 patients who underwent their first CA between January 2006 and December 2021. Patients were divided into those who continued OACs for 12 months (n=922), and those who discontinued them 12 months after CA (n=899). Follow-up data were collected until December 2023.
The results revealed that thromboembolic events occurred more frequently in the OAC discontinuation group, than the continuation group (incidence rate [IR] 0.86; 95% CI: 0.45–1.35 per 100 person-years vs 0.37; 95% CI: 0.22–0.54; p=0.04). In contrast, major bleeding events occurred less frequently in the discontinuation group, compared to the continuation group (IR 0.10; 95% CI: 0.02–0.19 vs IR 0.65; 95% CI: 0.43–0.90; p=0.001). Researchers observed no significant difference in all-cause mortality between groups. Subgroup analyses identified that OAC discontinuation was associated with higher thromboembolic risk in patients with asymptomatic AF, compared to symptomatic AF (hazard ratio [HR] 6.09; 95% CI: 2.38–15.57 vs 0.64; 95% CI: 0.25–1,64; p=0.001), lower left ventricular ejection fraction (LVEF) (<60%), compared to LVEF ≥60% (HR 5.06; 95% CI: 2.00–12.77 vs HR 1.05; 95% CI: 0.36–3.01; p=0.03), and larger left atrial diameter (≥45 mm compared to <45 mm) (HR 5.52; 95% CI: 2.12–14.38 vs HR 1.15; 95% CI: 0.48–2.74; p=0.02). On the contrary, OAC discontinuation was observed to provide a protective effect against major bleeding in patients with higher HAS-BLED scores (2 or greater) compared to lower HAS-BLED scores (less than 2) (HR 0.03; 95% CI: 0.004–0.21 vs 1.63; 95% CI: 0.28–9.39; p<0.001).
In conclusion, the study suggests that OAC discontinuation after successful CA may increase the risk of thromboembolic events while reducing major bleeding events, making it a potentially viable option for some patients. However, the decision to discontinue OACs should be considered based on individual risk profiles. Limitations include the study’s retrospective design, potential for selection bias, and the inability to assess adherence to therapy. Further prospective studies are needed to validate these findings and refine the optimal management strategies for patients undergoing CA for AF.
Reference
Iwawaki T et al. Discontinuation of Oral Anticoagulation After Successful Atrial Fibrillation Ablation. JAMA Netw Open. 2025;8(3):3251320
