Key result
Discontinuation of oral anticoagulation after successful atrial fibrillation ablation in high-risk patients showed no significant difference in cerebrovascular events (RR 0.85) compared to continuation, while continuation significantly increased the risk of major bleeding (RR 6.50).
Why the study?
Continuation of oral anticoagulation beyond 3 months after an apparently successful ablation of atrial fibrillation remains controversial.
Does continuation of oral anticoagulation compared to discontinuation affect the risk of cerebrovascular events, systemic thromboembolism, or major bleeding in patients with CHA2DS2VASC/CHADS2 score ≥2 after successful AF ablation?
Meta-Analysis (n=3,436)
Does continuation of oral anticoagulation compared to discontinuation affect the risk of cerebrovascular events, systemic thromboembolism, or major bleeding in patients with CHA2DS2VASC/CHADS2 score ≥2 after successful AF ablation?
Relative Risk: 0.85 (95% CI 0.42–1.7)
p-value: p=0.64
Discontinuing oral anticoagulation 3 months after successful AF ablation in patients with elevated stroke risk scores appears safe and significantly reduces major bleeding without increasing thromboembolic events.
May support discontinuing anticoagulation after successful ablation to reduce bleeding; leaves open confirmation by RCTs.
BACKGROUND: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently successful ablation of AF remains controversial. METHODS: A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, SCOPUS and Google Scholar. Studies comparing continuation vs discontinuation of OACs after an apparent successful ablation of AF among patients with CHA2DS2VASC or CHADS2 score ≥2were included. Clinical outcomes included cerebrovascular events, systemic thromboembolism and major bleeding. Risk ratios (RR) and 95% confidence intervals for above outcomes were calculated. RESULTS: Nine observational studies were eligible and included 3,436patients of whom 1,815 continued OACs and1,621 discontinued OAC post -AF ablation. There was no significant difference in risk of cerebrovascular events (RR: 0.85, 95%CI: 0.42 to 1.70, p= 0.64)and systemic thromboembolism (RR: 1.21, 95%CI: 0.66 to 2.23, p= 0.54)between the two groups. Continuation of OACs was associated with an increased risk of major bleeding (RR: 6.50, 95% CI: 2.53 to 16.74, p= 0.0001). CONCLUSION: In conclusion, discontinuation of oral anticoagulation 3 months after a successful AF ablation appears to be safe in highly selected closely monitored patients. Further randomized trials are warranted to assess the safety of discontinuing OACs after AF ablation.
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Varunsiri Atti (2018) conducted a meta-analysis in Atrial fibrillation post-catheter ablation (n=3,436). Discontinuation of oral anticoagulation vs. Continuation of oral anticoagulation was evaluated on Cerebrovascular events (RR 0.85, 95% CI 0.42 to 1.70, p=0.64). Discontinuation of oral anticoagulation after successful atrial fibrillation ablation in high-risk patients showed no significant difference in cerebrovascular events (RR 0.85) compared to continuation, while continuation significantly increased the risk of major bleeding (RR 6.50).
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