Abstract 4369583: Is It Safe to Discontinue Oral Anticoagulation After Catheter Ablation for Atrial Fibrillation? A Systematic Review and Meta-Analysis

Abstract

Introduction: Catheter ablation is a well-established rhythm control strategy for atrial fibrillation (AF), demonstrating superior efficacy compared to antiarrhythmic drug therapy. However, the optimal post-procedural management of oral anticoagulation (OAC) remains uncertain, particularly regarding whether OAC can be safely discontinued in patients without recurrent arrhythmias after the blanking period. Hypothesis: Discontinuing long-term anticoagulation after the blanking period is safe in patients undergoing catheter ablation for AF. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and observational studies comparing OAC discontinuation versus continuation in patients undergoing catheter ablation for AF. Data were analyzed using Cochrane RevMan (version 9.3.0), with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Heterogeneity was assessed using the I2 statistic, with p < 0.05 and I2 > 25% indicating significant heterogeneity. The primary outcomes were new thromboembolic events and major bleeding. Results: Our analysis included 23 studies (1 RCT and 22 observational studies) comprising a total of 145,489 patients, of whom 75,585 discontinued anticoagulation. OAC discontinuation did not significantly affect the occurrence of new thromboembolic events (OR 0.76; 95% CI 0.55–1.04; p = 0.08; Figure 1) and was associated with a significant reduction in the risk of major bleeding (OR 0.32; 95% CI 0.19–0.52; p = 0.0001; Figure 2) compared to the continuation of long-term anticoagulation. No significant differences in thromboembolic events were observed in a sensitivity analysis restricted to patients with a CHA2DS2-VASc score ≥ 2 (OR 1.00; 95% CI 0.65–1.53; p = 1.00). Conclusions: OAC discontinuation after the blanking period appears to be safe in patients undergoing catheter ablation for AF, with no increase in thromboembolic risk, even among high-risk individuals. Moreover, it significantly reduces the risk of major bleeding compared to long-term OAC continuation. These findings challenge the conventional practice of indefinite anticoagulation and suggest that discontinuation may be preferable in select patients; however, the limited randomized evidence warrants cautious interpretation.