Key result
Discontinuing oral anticoagulation in patients with an ongoing indication post-AF ablation showed no significant difference in stroke rate compared to continuing therapy (1.7% vs. 0.9%, P=0.299).
Why the study?
Current guidelines recommend oral anticoagulation following AF ablation based on CHA2DS2-VASc score regardless of ablation efficacy, leaving real-world post-ablation OAC patterns unclear.
Does discontinuation of oral anticoagulation despite indication or continuation without indication affect stroke and bleeding rates in patients post-atrial fibrillation ablation?
Cohort (n=2,282)
Yes
Does discontinuation of oral anticoagulation despite indication or continuation without indication affect stroke and bleeding rates in patients post-atrial fibrillation ablation?
Absolute Event Rate: 1.7% vs 0.9%
p-value: p=0.299
Real-world data suggests that discontinuing oral anticoagulation in highly selected patients following successful atrial fibrillation ablation may not increase stroke risk, despite current guidelines recommending continuation based on CHA2DS2-VASc score.
OAC discontinuation post-AF ablation despite indications occurs in real-world practice; leaves open optimal long-term strategies pending prospective data.
Background Current guidelines for oral anticoagulation (OAC) use following atrial fibrillation (AF) ablation are based on CHA 2 DS 2 -VASc score, regardless of ablation efficacy. Objective To elucidate real-world practice regarding OAC patterns post-ablation. Methods Data was collected from AF ablations within a multicenter healthcare system between 2015 and 2021. Based on guidelines, we assessed two groups: patients who 1) discontinued OAC at one year despite having indication (-AC/+I group); 2) continued OAC without indication (+AC/-I). Comparison groups included patients on OAC with indication (+AC/+I) and patients off OAC without indication (-AC/-I). The primary outcome was a composite of stroke and bleeding. The secondary outcome was composite ablation success. Results Of 2,282 patients (median CHA 2 DS 2 -VASc 3), 235 (10.3%) were in the -AC/+I group and 342 (15.0%) in the +AC/-I group. The -AC/+I group most commonly stopped OAC due to ablation success (55.7%). The +AC/I- group most frequently continued OAC due to AF recurrence (43.9%). The -AC/+I group had no difference in stroke rate compared to the +AC/+I group (1.7% vs. 0.9%, P=0.299). The +AC/-I group had no difference in bleeding compared to the -AC/-I group (0.3% vs. 0.9%, P=0.346). Conclusion Although OAC was discontinued in a tenth of patients with ongoing indication, mostly for ablation success, stroke rate did not differ from patients with indication on OAC. Conversely, nearly one-fifth continued OAC without indication, with no increased bleeding. Real-world practice suggests that OAC discontinuation may be feasible in highly selective patients, however these results should be interpreted with caution.
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Gasparis et al. (2026) conducted a cohort in Atrial fibrillation (n=2,282). Discontinuation of oral anticoagulation despite indication vs. Continuation of oral anticoagulation with indication was evaluated on Composite of stroke and bleeding (p=0.299). Discontinuing oral anticoagulation in patients with an ongoing indication post-AF ablation showed no significant difference in stroke rate compared to continuing therapy (1.7% vs. 0.9%, P=0.299).
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