Oral Anticoagulant Discontinuation After AF Ablation: Review Sheds Light on Risks and Benefits
Brazil: Stopping oral anticoagulants (OACs) after atrial fibrillation ablation does not significantly change overall thromboembolic (TE) event rates and is associated with a reduction in major bleeding. However, in patients with a CHA₂DS₂-VASc score greater than 2, discontinuation of OAC significantly increases the risk of thromboembolic events.
In a new systematic review and meta-analysis published in Heart Rhythm, Lucas M. Barbos from the Federal University of Minas Gerais, Brazil, and colleagues examined whether oral anticoagulants can be safely discontinued after catheter ablation for atrial fibrillation (AF). Given the elevated stroke risk associated with AF and the widespread use of ablation to restore sinus rhythm, determining the optimal duration of anticoagulation after the procedure remains a major clinical challenge, particularly in the absence of clear, universally accepted guidelines.
The researchers conducted a comprehensive search across four major databases to identify studies comparing continuation versus discontinuation of OAC therapy following AF ablation. A total of 32 studies were included in the analysis, encompassing 271,808 patients. Among them, 88,164 individuals, representing nearly one-third of the cohort, discontinued anticoagulation after ablation. The team reconstructed time-to-event data and applied random-effects models to assess outcomes for thromboembolic events, mortality, and major bleeding.
Key Findings:
- Stopping oral anticoagulants after atrial fibrillation ablation did not result in a significant difference in thromboembolic events compared with continued therapy.
- All-cause mortality rates were similar between patients who discontinued OACs and those who continued treatment.
- Discontinuation of anticoagulants was associated with a marked reduction in major bleeding events.
- Subgroup and sensitivity analyses stratified by CHA₂DS₂-VASc scores revealed a clear risk gradient.
- Patients with a CHA₂DS₂-VASc score greater than 2 experienced a significantly higher risk of thromboembolic events after stopping OACs.
- Patients with CHA₂DS₂-VASc scores of 0 to 2 did not show a significant increase in thromboembolic risk after OAC discontinuation.
- In low- to intermediate-risk patients, stopping OACs was linked to fewer major bleeding events.
- Patients who maintained sinus rhythm after ablation showed similar favorable outcomes, supporting selective OAC withdrawal in carefully chosen cases.
The authors note that while catheter ablation can effectively reduce AF burden, it does not eliminate underlying stroke risk in all patients. Their findings reinforce the importance of individualized decision-making that balances thromboembolic protection against bleeding risk, rather than a one-size-fits-all approach.
"Overall, the study suggests that discontinuing oral anticoagulants after AF ablation may be safe for patients at low thromboembolic risk, particularly those who remain in sinus rhythm. However, for patients with higher CHA₂DS₂-VASc scores, continued anticoagulation appears essential to prevent adverse cerebrovascular outcomes," the authors concluded.
Reference:
Barbosa LM, Rodrigues Oliveira VM, Rivera A, Araújo B, Barbosa Izoton Cabral DC, Consoli LN, Defante MLR, Queiroz I, Pereira Tartuce L, Nunes MDCP, Nascimento BR, Guimarães PO, Moreira HG, Lip GYH, Bhatt DL. Can Oral Anticoagulants Be Safely Discontinued Following Atrial Fibrillation Ablation? A Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data. Heart Rhythm. 2026 Jan 7:S1547-5271(26)00003-2. doi: 10.1016/j.hrthm.2025.12.037. Epub ahead of print. PMID: 41513055.
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