Key result
Discontinuing OAC after successful AF ablation increases thromboembolic events ~86% in patients with CHA2DS2-VASc ≥2.
Why the study?
Current guidelines lack sufficient evidence supporting long-term oral anticoagulation following successful atrial fibrillation catheter ablation, balancing thromboembolism prevention against increased bleeding risk.
Does continued long-term oral anticoagulation prevent thromboembolic events compared to discontinuation in post-ablation atrial fibrillation patients?
Meta-Analysis (n=22,429)
Does continued long-term oral anticoagulation prevent thromboembolic events compared to discontinuation in post-ablation atrial fibrillation patients?
Effect estimate: OR 1.86 (95% CI 1.02-3.40)
p-value: p=0.04
Continued oral anticoagulation after successful AF ablation in patients with CHA2DS2-VASc ≥2 reduces thromboembolic events but significantly increases the risk of major bleeding.
Continued OAC may lower thromboembolic risk post-ablation in CHA2DS2-VASc ≥2; extends mixed evidence but leaves optimal strategy open pending RCTs.
Oral anticoagulation (OAC) prevents thromboembolism yet greatly increases the risk of bleeding, inciting concern among clinicians. Current guidelines lack sufficient evidence supporting long-term OAC following successful atrial fibrillation catheter ablation (CA). A literature search was performed in PubMed, Google Scholar, Medline, and Scopus to seek out studies that compare continued and discontinued anticoagulation in post-ablation Atrial fibrillation (AF) patients. Funnel plots and Egger’s test examined potential bias. Via the random-effects model, summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using RevMan (5.4) and STATA (17.0). Twenty studies, including 22 429 patients (13 505 off-OAC) were analyzed. Stratified CHA 2 DS 2 -VASc score ≥2 examining thromboembolic events (TE) favored OAC continuation (OR 1.86; 95% CI: 1.02-3.40; P = .04). Sensitivity analysis demonstrated this association was attenuated. The on-OAC arm had greater incidence of major bleeding (MB) (OR 0.16; 95% CI: 0.08-0.95; P < .00001), particularly intracranial hemorrhage (ICH) and gastrointestinal bleeding (GI); (OR 0.17; 95% CI: 0.08-0.36; P < .00001) and (OR 0.12; 95% CI: 0.04-0.32; P < .0001), respectively. Our findings support sustained anticoagulation in patients with a CHA 2 DS 2 -VASc score of ≥2. Due to reduced outcome robustness, physician discretion is still advised.
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Maduray et al. (2022) conducted a meta-analysis in Atrial fibrillation (n=22,429). Discontinued oral anticoagulation (off-OAC) vs. Continued oral anticoagulation (on-OAC) was evaluated on Thromboembolic events (TE) in patients with CHA2DS2-VASc score ≥2 (OR 1.86, 95% CI 1.02-3.40, p=0.04). Discontinuing oral anticoagulation after successful atrial fibrillation ablation in patients with CHA2DS2-VASc ≥2 increased thromboembolic events (OR 1.86; 95% CI 1.02-3.40; P=0.04).
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