Arrhythmias & electrophysiologyMeta-analysis
Can oral anticoagulants be safely discontinued after atrial fibrillation ablation? A systematic review and meta-analysis of reconstructed time-to-event data
- systematic review and meta-analysis of reconstructed time-to-event data
- 4 databases
- random effects model
- sensitivity analyses using hazard ratios
- subgroups based on CHA2DS2-VASc scores and sinus rhythm status
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
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 events · reduced 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:10.1016/j.hrthm.2025.12.037
Summarised from the published abstract; every number is checked against it