Assessment of Long‐Term Use Versus Discontinuation of Direct Oral Anticoagulant After Catheter Ablation for Atrial Fibrillation—RYOUMA Registry Subanalysis

BACKGROUND: The relationship between oral anticoagulant (OAC) status after catheter ablation (CA) for atrial fibrillation (AF) and the risks of ischemic stroke or major bleeding events is still unknown. METHODS: This is a subanalysis of the RYOUMA registry, a prospective multicenter observational study of Japanese patients who underwent CA for AF in 2017-2018. RESULTS: Of the 2844 patients, the rate of DOAC continuation was 48.1%, 69.6%, and 80.9% in patients with a CHADS2 score of 0-1, 2, and 3-6, respectively. Among the patients taking DOACs with a CHADS2 score of 0-1 and 2, the incidence rates of major bleeding were significantly higher than those of ischemic stroke or systemic embolic events (SEEs) (1.3%/year [95% CI, 0.6-2.1] vs. 0.3%/year [95% CI, 0.0-0.7], p = 0.019; 1.8%/year [95% CI, 0.6-3.0] vs. 0.2%/year [95% CI, 0.0-0.6], p = 0.018, respectively). However, there was no difference between the incidence rates of major bleeding events and ischemic stroke or SEEs in patients taking DOACs with a CHADS2 score of 3-6 (1.6%/year [95% CI, 0.2-3.0] vs. 1.0%/year [95% CI, 0.0-2.1], p = 0.474). CONCLUSIONS: In patients with a CHADS2 score of 2, those who continued taking DOACs had a higher incidence rate of major bleeding events compared to ischemic stroke/SEEs, similar to those with a CHADS2 score of 0-1. Conversely, in patients with a CHADS2 score of 3-6, the incidence rates of both ischemic stroke/SEEs and major bleeding were similarly high. TRIAL REGISTRATION: The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry).