Key result
Discontinuing OAC after successful AF ablation shows no difference in thromboembolism risk versus continuation.
Why the study?
The safety of discontinuing OACs after AF ablation beyond the blanking period remains controversial due to divergences between consensus recommendations and clinical practice.
Does discontinuation of oral anticoagulants reduce major bleeding without increasing thromboembolism in patients after successful atrial fibrillation ablation?
Meta-Analysis (n=23,942)
Does discontinuation of oral anticoagulants reduce major bleeding without increasing thromboembolism in patients after successful atrial fibrillation ablation?
Effect estimate: OR 0.66 (95% CI 0.43-1.01)
Discontinuing oral anticoagulants after successful atrial fibrillation ablation appears safe, significantly reducing major bleeding risk without increasing the risk of thromboembolism.
Discontinuing OACs after successful AF ablation may lower major bleeding without raising thromboembolism risk; leaves open confirmation by randomized trials.
BACKGROUND: Current guidelines recommended that oral anticoagulants (OACs) should last for a minimum first 2 months after atrial fibrillation (AF) ablation and the long-term decision of anticoagulation after AF ablation should be based on the individual patient's risk of stroke rather than the rhythm status. There is controversy about the safety of discontinuing OACs in patients with atrial fibrillation after the blanking period due to the divergences between consensus recommendations and clinical practice. METHODS: Electronic bibliographic sources (PubMed, Embase, and Web of Science) were searched until August 2023 to identify cohort studies about the safety of discontinuing OACs in patients with AF after the blanking period. The primary outcome was thromboembolism (TE). The secondary outcome was major bleeding events (MBEs). Two authors extracted articles independently using predefined data fields. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated based on a random-effects model. RESULTS: A total of 16 studies (11 prospective cohorts and 5 retrospective cohorts) enrolling 23,942 patients (14,382 OFF-OAC and 9560 ON-OAC) were included in our analysis. No significant difference emerged in the risk of TE between OFF-OAC and ON-OAC patients following AF ablation after the banking period (OR = 0.66; 95%CI, 0.43-1.01). Similar results emerged in the patients with a high risk of TE after stratification by the risk level of TE (OR = 0.72; 95%CI, 0.25-2.08). A significant reduction in incidences of major bleeding was found in the OFF-OAC patients compared with the ON-OAC patients (OR = 0.23; 95%CI, 0.12-0.42). Subgroup analyses for TE found a reduction of incidences in the subgroups who switched to antiplatelet drugs and with a follow-up duration <3 years. Subgroup analyses for MBEs found a significant reduction of incidences in all subgroups. CONCLUSIONS: Our study suggests it can be safe to discontinue OACs after successful AF ablation. Discontinuation of OACs may reduce the risk of MBEs while not increasing the risk of TE.
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Wang et al. (2023) conducted a meta-analysis in Atrial fibrillation (n=23,942). Discontinuation of oral anticoagulants (OFF-OAC) vs. Continuation of oral anticoagulants (ON-OAC) was evaluated on Thromboembolism (TE) (OR 0.66, 95% CI 0.43-1.01). Discontinuing oral anticoagulants after successful atrial fibrillation ablation showed no significant difference in thromboembolism risk compared to continuation (OR 0.66; 95% CI 0.43-1.01).
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