Increased Risk of Adverse Events After Stopping Anticoagulation Post-Afib Ablation: JAMA

"These findings highlight the need for a more refined risk assessment that considers individual patient characteristics to balance the likelihood of these two opposing events," the researchers wrote.

AF is a common cardiac arrhythmia that significantly raises the likelihood of stroke. Catheter ablation is often performed to restore normal heart rhythm, with many patients remaining on OACs afterward to prevent thromboembolic events. The decision to discontinue oral anticoagulants after catheter ablation (CA) for atrial fibrillation remains a topic of ongoing debate.

To address this uncertainty, Tomoya Iwawaki, Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan, and colleagues aimed to analyze thromboembolic and major bleeding events, all-cause mortality, and the patient characteristics influencing prognoses following OAC discontinuation after successful catheter ablation.

For this purpose, the researchers conducted a retrospective cohort study involving patients who had undergone their first catheter ablation between January 1, 2006, and December 31, 2021. Only those without atrial fibrillation recurrence or adverse events for 12 months post-procedure were included. Patients were categorized based on whether they continued or discontinued oral anticoagulants at 12 months.

Follow-up data were collected until December 31, 2023, with analyses performed from January to April 2024. The study assessed thromboembolic and major bleeding events and all-cause mortality, using IPTW and propensity score–matched analyses to adjust for baseline characteristics.

Key Findings:

• The study included 1,821 patients, with an average age of 63.6 years, of whom 73.5% were men. Nine twenty-two patients (50.6%) continued OAC for 12 months, while 899 (49.4%) discontinued it.
• Over an average follow-up of 4.8 years, thromboembolic events occurred in 2.4% of patients, major bleeding in 2.3%, and death in 3.9%.
• After IPTW adjustment, OAC discontinuation was linked to a higher incidence of thromboembolism (0.86 vs. 0.37 per 100 person-years) and a lower incidence of major bleeding (0.10 vs. 0.65 per 100 person-years).
• The risk of thromboembolism was higher in patients with asymptomatic AF, left ventricular ejection fraction below 60%, and left atrial diameter of 45 mm or more.
• Discontinuing OAC reduced major bleeding risks in patients with a HAS-BLED score of 2 or greater.
• The propensity score–matched analysis of 1,100 paired patients showed similar trends, except for no significant difference in thromboembolic events.
• Mortality rates between the two groups did not show statistically significant differences.

This retrospective cohort study found that discontinuing OACs 12 months after CA for AF increased thromboembolic risk while reducing major bleeding events. The decision to stop OACs depended on a balanced assessment of these risks based on specific patient characteristics.

"Further prospective randomized studies are needed to establish optimal anticoagulation strategies post-ablation," the authors concluded.

Reference:

Iwawaki T, Yanagisawa S, Inden Y, et al. Discontinuation of Oral Anticoagulation After Successful Atrial Fibrillation Ablation. JAMA Netw Open. 2025;8(3):e251320. doi:10.1001/jamanetworkopen.2025.1320