Key result
Continuing OAC after AF ablation fails to reduce stroke but increases major bleeding.
Why the study?
Continuation of OAC after successful AF ablation remains debated, and recent randomized controlled trials prompted an updated meta-analysis to inform clinical decision-making.
Does continuing oral anticoagulation reduce stroke or TIA in adult patients with atrial fibrillation after catheter ablation?
Meta-Analysis (n=50,327)
Yes
Does continuing oral anticoagulation reduce stroke or TIA in adult patients with atrial fibrillation after catheter ablation?
Odds Ratio: 1.48 (95% CI 0.84–2.6)
p-value: p=0.16
Continuing oral anticoagulation post-ablation reduces thromboembolic events in high-risk patients (CHA2DS2-VASc ≥2) but increases major bleeding overall, suggesting discontinuation may be safer for lower-risk patients.
No overall stroke benefit with continued OAC post-ablation but increased bleeding warrants caution; leaves open benefit in CHA2DS2-VASc ≥2 patients.
AIMS: Continuation of oral anticoagulation (OAC) after successful atrial fibrillation (AF) ablation remains debated. With recent randomized controlled trials addressing this question, an updated meta-analysis is needed to inform clinical decision-making. METHODS AND RESULTS: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was performed through 24 November 2025, to identify studies comparing clinical outcomes in patients who continued vs. discontinued OAC after AF catheter ablation. Overall, continuing OAC was not significantly associated with the risk of stroke/TIA (OR: 1.48, 95% CI: 0.84-2.60; P = 0.16). However, when stratified by CHA2DS2-VASc score, patients with scores ≥2 had a significantly lower risk of stroke/TIA with OAC continuation (OR: 0.42, 95% CI: 0.18-0.95; P = 0.04). This protective effect was further supported in studies with well-balanced baseline risk between groups, where OAC continuation was associated with a significantly lower risk of stroke/TIA (OR: 0.50, 95% CI: 0.34-0.72; P < 0.01). Conversely, OAC continuation significantly increased the risk of major bleeding. No significant association was observed for major adverse cardiac events or all-cause mortality. CONCLUSION: In patients with CHA2DS2-VASc scores ≥2, particularly when baseline risk is well-balanced between groups, continuation of OAC after AF ablation is associated with a significantly lower risk of stroke/TIA. These findings support continuing OAC in higher-risk patients (CHA2DS2-VASc ≥2). However, given the significantly increased risk of major bleeding associated with OAC continuation, the decision to continue anticoagulation in lower-risk patients requires careful consideration, as no clear thromboembolic benefit was observed in this population.
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Nayak et al. (2026) conducted a meta-analysis in Atrial fibrillation undergoing catheter ablation (n=50,327). Continuation of oral anticoagulation vs. Discontinuation of oral anticoagulation was evaluated on Stroke or TIA (OR 1.48, 95% CI 0.84-2.60, p=0.16). Continuation of oral anticoagulation after atrial fibrillation ablation was not significantly associated with stroke or TIA risk (OR 1.48, p=0.16) but increased major bleeding risk (OR 4.62, p<0.01).
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