JAMA Netw Open

Is it safe to discontinue oral anticoagulants after successful afib ablation?

March 26, 2025

Study details: This retrospective cohort study evaluated the outcomes of discontinuing oral anticoagulation (OAC) in patients who had no afib recurrence or adverse events 12 months post-catheter ablation (CA). The study included 1,821 patients who underwent their first CA between 2006 and 2021, with follow-up data until December 2023. Patients were divided into two groups: those who continued OAC and those who discontinued it after 12 months.

Results: Discontinuing OAC was associated with a higher incidence of thromboembolic events (0.86 vs. 0.37 per 100 person-years; P=0.04) and a lower incidence of major bleeding (0.10 vs. 0.65 per 100 person-years; P<0.001) compared with those who continued OAC. Subgroup analysis showed that OAC discontinuation increased thromboembolism risk in patients with asymptomatic afib, LVEF <60%, and left atrial diameter ≥45 mm. Conversely, discontinuation reduced major bleeding risks in patients with a HAS-BLED score ≥2.

Clinical impact: While discontinuing OAC after successful afib ablation can reduce bleeding risks, it may increase thromboembolic events, particularly in high-risk patients. These results highlight the need for individualized patient assessment when considering OAC discontinuation post-ablation and underscore the importance of prospective randomized studies to further guide clinical decision-making.

Source:

Iwawaki T, et al. (2025, March 21). JAMA Netw Open. Discontinuation of Oral Anticoagulation After Successful Atrial Fibrillation Ablation. https://pubmed.ncbi.nlm.nih.gov/40116829/