Arrhythmias & electrophysiology
Can oral anticoagulants be safely discontinued after atrial fibrillation ablation? A systematic review and meta-analysis of reconstructed time-to-event data
An erratum to this article was published (Heart Rhythm, 1 Sep 2026 ↗)
Authors' conclusion
Discontinuation of OACs in patients with AF postablation did not significantly affect the overall TE incidence but was associated with a notable reduction in major bleeding events. However, there was a significant increase in TE risk in patients with a CHA2DS2-VASc score >2 upon discontinuation.
Study context
- Population
- Patients with atrial fibrillation (AF) after catheter ablation32 studies, 88,164 (32.4%) discontinuing oral anticoagulation (OAC) use after ablation
- Participants
- 271,808 patients
- Comparison
- OAC discontinuation with maintenance in patients with AF postablation
- OAC discontinuationn = 88,164
- Outcome
- TE incidence and mortality
Methodological details4 databases, random effects model, sensitivity analyses using hazard ratios, subgroups based on CHA2DS2-VASc scores and sinus rhythm status
- 4 databases
- Random effects model
- Sensitivity analyses using hazard ratios
- Subgroups based on CHA2DS2-VASc scores and sinus rhythm status
Pooled result
As reported in the abstract
OAC discontinuation vs OAC maintenanceOdds ratio (95% CI)P value
TE incidence; no significant difference
0.90(0.68–1.20)
P = 0.47Mortality; no significant difference
0.85(0.67–1.08)
P = 0.19Further pooled results
TE risk, CHA2DS2-VASc score >2 (subgroup)
- Discontinuing OAC significantly increased TE risk
CHA2DS2-VASc scores 0-2 and sustained sinus rhythm (subgroups)
- Results consistent with the overall analysis
Safety
| Outcome | OR | P value |
|---|---|---|
| Major bleeding eventsReduced with discontinuation | 0.35 | P < 0.01 |
Original publication
Can oral anticoagulants be safely discontinued after atrial fibrillation ablation? A systematic review and meta-analysis of reconstructed time-to-event data. Heart Rhythm. Published 7 January 2026. doi:10.
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