What question did this study set out to answer?

To assess the safety and outcomes of discontinuing anticoagulation therapy following atrial fibrillation ablation.

March 13, 2026

Discontinuation of Anticoagulation Therapy After Atrial Fibrillation Ablation: The ALONE-AF and OCEAN Studies

Key Result

Discontinuation of anticoagulation in patients without AF recurrence after ablation reduced major bleeding events, with similar stroke rates compared to those who continued OAC.

Key Points

To assess the safety and outcomes of discontinuing anticoagulation therapy following atrial fibrillation ablation.
Conducted two randomized trials: ALONE-AF and OCEAN.
Compared outcomes of patients who discontinued vs. continued anticoagulation therapy after one year post-ablation.
Evaluated incidence of stroke, systemic embolism, and bleeding events over specified periods.
Discontinuation of anticoagulation showed significantly lower rates of major bleeding in patients without AF recurrence.
No significant difference in stroke rates between groups—low thromboembolic events reported.
Rivaroxaban did not significantly reduce thromboembolic events but increased non-major bleeding risk.

Structured PICO

Does discontinuation of oral anticoagulation therapy improve outcomes in patients without atrial fibrillation recurrence one year after ablation?

Population

Patients with no documented atrial fibrillation (AF) recurrence at one year after transcatheter ablation

Intervention

Discontinuation of oral anticoagulation (OAC) (ALONE-AF) or rivaroxaban 15 mg (OCEAN)

Comparator

Continuation of OAC therapy (ALONE-AF) or acetylsalicylic acid (ASA) (OCEAN)

Outcome

Composite of stroke, systemic embolism, and major bleeding (ALONE-AF); stroke, systemic embolism, or new silent embolic cerebral infarction (OCEAN)composite

Discontinuation of oral anticoagulation may be a clinically reasonable option in low-risk patients without AF recurrence for at least one year after ablation, supported by optimal rhythm monitoring.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Two randomized trials, the ALONE-AF and OCEAN, have provided valuable evidence to guide the management of oral anticoagulation (OAC) therapy after ablation of atrial fibrillation (AF). In the ALONE-AF study, among patients with no documented AF recurrence at one year after transcatheter ablation, the 2-year incidence of the composite endpoint of stroke, systemic embolism, and major bleeding was significantly lower in those who discontinued OAC compared with those who continued therapy. This difference was driven by a reduction in major bleeding events, with similar rates of stroke between groups. In the OCEAN study, among patients without AF recurrence during the year following transcatheter ablation, rivaroxaban 15 mg, compared with acetylsalicylic acid (ASA), did not significantly reduce the 3-year incidence of stroke, systemic embolism, or new silent embolic cerebral infarction, but was associated with an increased risk of clinically relevant non-major bleeding. The annualized incidence of thromboembolic events was low (0.3–0.6 events per 100 patient-years). Taken together, data from these two trials suggest that discontinuation of OAC may be a clinically reasonable option in patients without AF recurrence for at least one year after ablation. This strategy should be limited to patients at low thromboembolic risk, comparable to those enrolled in the two trials. Furthermore, the implementation of optimal and sustainable rhythm-monitoring strategies is essential to support decisions regarding OAC discontinuation after AF ablation.

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