BACKGROUND: Current guidelines recommend indefinite oral anticoagulant (OAC) therapy for atrial fibrillation (AF) patients with stroke risk factors, regardless of catheter ablation (CA) outcomes. However, these recommendations are largely based on nonrandomized evidence, and the long-term anticoagulation strategy for patients after successful CA for AF remains uncertain.
OBJECTIVE: To evaluate the efficacy and safety of discontinuing OAC versus continuing OAC in AF with successful CA.
METHODS: We searched PubMed, Embase, and major conference proceedings from inception to November 2025 to identify eligible randomized controlled trials (RCTs). Pooled effect estimates were calculated as risk differences (RDs) with 95% confidence intervals (CIs).
RESULTS: A total of 2,324 patients were included across three RCTs, with the mean age ranging from 63 to 67 years, 71.4% were men, and the average CHA2DS2-VASc score was approximately 2. Among patients with successful CA, OAC discontinuation was not associated with a significant increase in the risks of stroke, ischemic stroke, stroke or systemic embolism, transient ischemic attack, and all-cause death. In contrast, continued OAC was associated with significantly higher risks of major bleeding (RD: 1.0%, 95% CI: 0.2-1.7), intracranial bleeding (RD: 0.6%, 95 CI: 0.0-1.1), minor bleeding (RD: 2.2%, 95% CI: 0.2-4.1), and clinically relevant nonmajor bleeding (RD: 2.5%, 95% CI: 1.2-3.9). No statistically significant difference was observed in gastrointestinal bleeding between groups.
CONCLUSION: In patients with AF and moderate baseline stroke risk after successful CA, discontinuation of OAC was associated with a lower risk of bleeding complications and was not associated with a statistically significant increase in thromboembolic events. These findings are primarily applicable to patients with moderate stroke risk and should not be extrapolated to higher-risk populations.
| Discipline Area | Score |
|---|---|
| Physician |  |
, McMaster University