Key result
Discontinuing OACs after AF ablation shows no difference in thromboembolic events compared to continuation.
Why the study?
The safety of discontinuing oral anticoagulants in patients with atrial fibrillation after ablation remains controversial, with explicit guidelines lacking and clinical practice varying.
Does the discontinuation of oral anticoagulants reduce bleeding without increasing thromboembolic events in patients with atrial fibrillation following ablation?
Meta-Analysis (n=16,037)
Does the discontinuation of oral anticoagulants reduce bleeding without increasing thromboembolic events in patients with atrial fibrillation following ablation?
Odds Ratio: 0.81 (95% CI 0.52–1.29)
Discontinuing oral anticoagulants after successful atrial fibrillation ablation appears safe, maintaining similar thromboembolic risk while significantly reducing bleeding risk compared to continuing therapy.
No difference in thromboembolic events with lower bleeding supports considering OAC discontinuation after successful AF ablation; leaves open confirmation by RCTs.
The safety of discontinuing oral anticoagulants (OACs) in patients with atrial fibrillation (AF) following ablation remains controversial. The European Society of Cardiology stated that the long-term continuation of anticoagulants beyond 2 months following ablation should be based on the patient’s stroke risk profile; however, the decision remains challenging considering the lack of explicit guidelines. Furthermore, a worldwide survey showed that some centers implement a policy of withdrawing OAC therapy even in the majority of patients at high risk of thromboembolic events. To address this issue, we conducted a systematic review to investigate the safety of discontinuing OACs in patients with AF following ablation. A systematic review of cohort studies was performed. A comprehensive search for relevant literature was conducted using predefined keywords in five scientific databases (PubMed, ClinicalKey, Cochrane, EBSCOhost, and ScienceDirect). Studies that compared the incidence of thromboembolic events in the off-OAC group and on-OAC group were considered. Duplicated articles were removed. Eight studies ( n = 16037) were retained for the final analysis. These studies were published between 2010 and 2021. Overall, there was no difference in the incidence of thromboembolic events between the off-OAC and on-OAC groups (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.52–1.29) with lower bleeding risk in patients who discontinued OAC compared to those who remained on OAC (OR 0.30; 95% CI 0.15–0.62). Patients who discontinued OAC after AF ablation generally had a similar incidence of thromboembolism (TE) to patients who remained on OAC. This review indicates that the risk-benefit ratio favors the discontinuation of OAC in patients with successful AF ablation. However, randomized controlled trials with larger samples involving a more generalizable population are warranted to address the safety and efficacy of OAC discontinuation in patients with AF undergoing catheter ablation.
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Fikri et al. (2023) conducted a meta-analysis in Atrial Fibrillation following Ablation (n=16,037). Discontinuation of oral anticoagulants (off-OAC) vs. Continuation of oral anticoagulants (on-OAC) was evaluated on incidence of thromboembolic events (OR 0.81, 95% CI 0.52-1.29). Discontinuation of oral anticoagulants after atrial fibrillation ablation showed no difference in thromboembolic events compared to continuation (OR 0.81; 95% CI 0.52-1.29).
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