Key result
Discontinuing OAC after successful AF ablation shows no difference in thromboembolism compared to continuation.
Why the study?
The safety of discontinuing oral anticoagulant therapy after atrial fibrillation ablation remains controversial.
Does discontinuation of oral anticoagulant therapy increase the risk of thromboembolism or reduce major bleeding in patients after successful atrial fibrillation ablation?
Meta-Analysis (n=11,148)
Does discontinuation of oral anticoagulant therapy increase the risk of thromboembolism or reduce major bleeding in patients after successful atrial fibrillation ablation?
Effect estimate: OR 0.73 (95% CI 0.51-1.05)
Discontinuing oral anticoagulation after successful AF ablation appears safe regarding thromboembolic risk and significantly reduces major bleeding compared to continuing therapy.
May support OAC discontinuation after successful AF ablation to reduce bleeding; leaves open randomized confirmation of TE safety.
BACKGROUND: The safety of discontinuing oral anticoagulant (OAC) therapy after atrial fibrillation (AF) ablation remains controversial. A meta-analysis was performed to assess the safety and feasibility of discontinuing OAC therapy after successful AF ablation. METHODS: PubMed and Embase were searched up to October 2020 for prospective cohort studies that reported the risk of thromboembolism (TE) after successful AF ablation in off-OAC and on-OAC groups. The primary outcome was the incidence of TE events. The Mantel-Haenszel method with random-effects modeling was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 11,148 patients (7,160 in the off-OAC group and 3,988 in the on-OAC group) from 10 studies were included to meta-analysis. No significant difference in TE between both groups was observed (OR, 0.73; 95%CI, 0.51-1.05; I2 = 0.0%). The risk of major bleeding in off-OAC group was significantly lower compared to the on-OAC group (OR, 0.18; 95%CI, 0.07-0.51; I2 = 51.7%). CONCLUSIONS: Our study suggests that it may be safe to discontinue OAC therapy in patients after successful AF ablation. Additionally, an increased risk of major bleeding was observed in patients on OAC. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the included study designs. Large-scale and adequately powered randomized controlled trials are warranted to confirm these findings.
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Liu et al. (2021) conducted a meta-analysis in Atrial fibrillation (n=11,148). Discontinuation of oral anticoagulant (OAC) therapy vs. Continuation of oral anticoagulant (OAC) therapy was evaluated on Incidence of thromboembolism (TE) events (OR 0.73, 95% CI 0.51-1.05). Discontinuing oral anticoagulation therapy after successful atrial fibrillation ablation showed no significant difference in thromboembolism compared to continuation (OR 0.73; 95% CI 0.51-1.05).
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