Discontinuation of oral anticoagulation after successful atrial fibrillation ablation did not significantly alter thromboembolism risk (OR 0.91; 95% CI 0.64-1.30; P=0.60) but reduced major bleeding.
Meta-Analysis (n=153,352)
Does discontinuation of oral anticoagulants reduce major bleeding or alter thromboembolism risk in patients after successful atrial fibrillation ablation?
Discontinuation of oral anticoagulants after successful AF ablation significantly reduces major bleeding without increasing thromboembolic or mortality risk.
Odds Ratio: 0.91 (95% CI 0.64–1.3)
p-value: p=0.60
The optimal duration of oral anticoagulation (OAC) after successful atrial fibrillation (AF) ablation remains uncertain. We performed an updated meta-analysis comparing postablation OAC continuation (ON-OAC) versus discontinuation (OFF-OAC). A systematic search of MEDLINE, Scopus, and Cochrane CENTRAL was performed from inception until March 2026. We included randomized controlled trials and cohort studies evaluating patients receiving ≥3 months of OAC after AF ablation. Primary outcome was thromboembolism; secondary outcomes were major bleeding, all-cause mortality, and AF recurrence. Random-effect models pooled the effect estimates. Twenty-nine studies (n = 153,352) were included. OFF-OAC did not significantly alter thromboembolism risk odds ratio (OR): 0.91; 95% confidence interval (CI), 0.64–1.30; P = 0.60, all-cause mortality (OR: 0.67; 95% CI, 0.44–1.02; P = 0.06), or AF recurrence. OFF-OAC significantly reduced major bleeding risk (OR: 0.34; 95% CI, 0.23–0.49; P < 0.00001). Subgroup analysis showed significant effect modification by OAC type, region, and antiplatelet switch. Discontinuation of warfarin (OR: 0.13; 95% CI, 0.05–0.39) or warfarin/nonvitamin K antagonist oral anticoagulants (OR: 0.43; 95% CI, 0.31–0.61) reduced major bleeding ( P = 0.04). Greater bleeding risk reduction was observed in non-Asian cohorts (OR: 0.12; 95% CI, 0.04–0.35) versus Asian (OR: 0.45; 95% CI, 0.31–0.64; P = 0.02). Patients switched to antiplatelet therapy also showed lower bleeding risk (OR: 0.18; 95% CI, 0.08–0.39) compared with those not switched (OR: 0.44; 95% CI, 0.28–0.71; P = 0.05). Discontinuation of OAC after AF ablation significantly reduces major bleeding without increasing thromboembolic or mortality risk in appropriately selected patients. Individualized risk stratification is essential to guide postablation anticoagulation decisions.
Tahir et al. (Fri,) conducted a meta-analysis in Atrial fibrillation after successful ablation (n=153,352). Discontinuation of oral anticoagulation (OFF-OAC) vs. Continuation of oral anticoagulation (ON-OAC) was evaluated on Thromboembolism (OR 0.91, 95% CI 0.64-1.30, p=0.60). Discontinuation of oral anticoagulation after successful atrial fibrillation ablation did not significantly alter thromboembolism risk (OR 0.91; 95% CI 0.64-1.30; P=0.60) but reduced major bleeding.