Long‐term aspirin does not lower risk of stroke and increases bleeding risk in low‐risk atrial fibrillation ablation patients

Background Stroke risk is a significant concern in patients with atrial fibrillation (AF). Low stroke risk patients (CHADS 2 VASc 0–2) are often treated long‐term with aspirin after catheter ablation. Defining the long‐term risks versus benefits of aspirin therapy, after an ablation, is essential to validate this common clinical approach. Methods A total of 4,124 AF ablation patients undergoing their index ablation were included in this retrospective observational study. We compared 1‐ and 3‐year outcomes for cerebrovascular accident (CVA), transient ischemic attack (TIA), gastrointestinal (GI) bleeding, genitourinary (GU) bleeding, any bleeding, and AF recurrence among patients receiving: none, aspirin, or warfarin as long‐term therapies. Results Patient distribution by CHADS 2 VASc scores was as follows: 0: 1,143 (28%), 1: 1,588 (39%), and 2: 1,393 (34%). Significantly higher incidents of: female gender, hypertension, diabetes mellitus, heart failure, and vascular disease were seen with higher CHADS 2 VASc scores (P < 0.0001 for all). At 3 years, 238 (5.9%) patients were on warfarin, 743 (18.6) on aspirin, and 3,013 (75.5%) on no therapy; with occurrences of CVA/TIA (1.4%, 3.0%, 3.9%, P < 0.0001, respectively), GI bleeding (0.8%, 1.9%, 1.1%, P = 0.06, respectively), and GU bleeding (1.7%, 2.8%, 2.1%, P = 0.008, respectively) that increased with advancing CHA 2 DS 2 VASc score. There was a significantly increased risk for both CVA/TIA with aspirin therapy, when compared to no therapy or warfarin therapy in general, and across all CHA 2 DS 2 VASc scores. Conclusions After catheter ablation, low risk patients do not benefit from long‐term aspirin therapy, but are at risk for higher rates of bleeding when compared to no therapy or warfarin.