Key result
Interrupted OAC after AF ablation reduces hemorrhagic events ~82% in CHA2DS2-VASc ≤1 without increasing thromboembolism.
Why the study?
The safety of suspending oral anticoagulation after successful AF catheter ablation remains unclear, and prior studies have not stratified outcomes by CHA2DS2-VASc score.
Does interrupted oral anticoagulation reduce hemorrhagic events without increasing thromboembolic events compared to uninterrupted oral anticoagulation in patients after successful atrial fibrillation catheter ablation?
Meta-Analysis (n=128,144)
Does interrupted oral anticoagulation reduce hemorrhagic events without increasing thromboembolic events compared to uninterrupted oral anticoagulation in patients after successful atrial fibrillation catheter ablation?
Effect estimate: RR 0.87 (95% CI 0.51-1.48)
p-value: p=0.61
Interruption of oral anticoagulation after successful AF ablation appears safe and reduces hemorrhagic risk without increasing thromboembolic events across all CHA₂DS₂-VASc strata.
Background and aims The safety of suspending oral anticoagulation (OAC) after successful atrial fibrillation (AF) catheter ablation remains unclear, and prior studies have not stratified outcomes by CHA₂DS₂-VASc score. This meta-analysis evaluates thromboembolic and hemorrhagic cerebrovascular events in patients with interrupted versus uninterrupted OAC following ablation. Methods A comprehensive search of electronic databases through December 2025 identified studies comparing interrupted versus uninterrupted OAC after successful AF ablation, including vitamin K antagonists and direct oral anticoagulants. One non-randomized controlled trial, eight retrospective cohort studies (two with propensity score matching), and two prospective cohort studies were included. Outcomes included thromboembolic and hemorrhagic events stratified by CHA₂DS₂-VASc scores ≤1 and ≥2. Results Among 128,144 patients with AF after ablation (62,224 uninterrupted; 65,920 interrupted; 11 studies), no significant difference in thromboembolic events was observed between groups: CHA₂DS₂-VASc ≤1 (RR 0.87, 95%CI 0.51–1.48, p=0.61) and CHA₂DS₂-VASc ≥2 (RR 1.12, 95%CI 0.82–1.52, p=0.49). Interrupted OAC was associated with a significant reduction in hemorrhagic events in both risk strata: CHA₂DS₂-VASc ≤1 (RR 0.18, 95%CI 0.06–0.61, p=0.006) and CHA₂DS₂-VASc ≥2 (RR 0.27, 95%CI 0.09–0.78, p=0.02). Conclusions Interruption of OAC after successful AF ablation appears safe across CHA₂DS₂-VASc strata, with reduced hemorrhagic risk and no increase in thromboembolic events. These findings question routine post-ablation OAC continuation and warrant confirmation in randomized controlled trials. Conflict of interest Amiel Armando Aragon Cortes. Nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Conclusions Figure 3 - belongs to Conclusions
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Cortes et al. (2026) conducted a meta-analysis in Atrial fibrillation after successful catheter ablation (n=128,144). Interrupted oral anticoagulation vs. Uninterrupted oral anticoagulation was evaluated on Thromboembolic events in patients with CHA2DS2-VASc ≤1 (RR 0.87, 95% CI 0.51-1.48, p=0.61). Interrupted oral anticoagulation after successful AF ablation reduced hemorrhagic events in patients with CHA2DS2-VASc ≤1 (RR 0.18; 95% CI 0.06-0.61; p=0.006) without increasing thromboembolic risk.
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