Oral Anticoagulant Discontinuation after AF Ablation not tied to Cognitive Decline: Study

A substudy of the ALONE-AF trial published in the journal of Heart Rhythm found that patients who discontinued oral anticoagulation (OAC) after remaining free of atrial fibrillation (AF) recurrence for at least one year following catheter ablation did not experience deterioration in cognitive function.

While OACs reduce stroke risk, they also carry bleeding risks and long-term treatment burdens. For patients whose AF appears successfully treated after ablation, the possibility of safely stopping these medications is appealing. However, the potential impact on brain health has remained uncertain.

Thus, this investigation focused on a subgroup of participants from the ALONE-AF trial. All included patients were between 19 and 80 years old, had no recurrence of atrial arrhythmia for at least 12 months following ablation, and had at least one stroke risk factor unrelated to sex. A total of 646 participants who completed cognitive testing at baseline and at two years were analyzed, of which 318 discontinued OAC therapy and 328 continued it.

Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) to evaluate memory, attention, language, and executive function. At the start of the study, average MoCA scores were similar between groups.

After two years, both groups showed modest improvements. The average score of no-OAC group rose from 24.4 to 25.0, while the OAC group increased from 24.2 to 24.9. Statistically, there was no meaningful difference between the groups in overall cognitive change. Likewise, no differences were detected across individual cognitive domains such as memory, attention, or visuospatial skills.

The findings suggest that stopping anticoagulants may not negatively affect cognitive performance in patients without AF recurrence for at least a year after ablation.

The study observed improvements in both groups that could reflect practice effects or other external factors rather than true cognitive gains. Additionally, the follow-up period, while substantial, may not capture longer-term changes in brain health.

Clinicians emphasize that decisions about stopping OAC therapy should remain individualized, taking into account stroke risk, bleeding risk, and patient preferences. While this study adds an important piece to the puzzle, it does not provide a definitive answer.

Reference:

Chung, H.-G., Oh, I.-Y., Kim, J., Yang, P.-S., Shim, J., Choi, E.-K., Lee, Y. S., Park, J., Ko, J.-S., Park, K.-M., Sung, J.-H., Park, H. W., Park, H.-S., Kim, J.-Y., Kang, K.-W., Kim, D., Park, J.-K., Kim, D.-H., Kim, J.-B., … Joung, B. (2026). Cognitive function and anticoagulation discontinuation in patients without long-term recurrence after catheter ablation for atrial fibrillation: A substudy of the ALONE-AF trial. Heart Rhythm: The Official Journal of the Heart Rhythm Society. https://doi.org/10.1016/j.hrthm.2026.04.023