Arrhythmias & electrophysiology
Optimal Timing for Oral Anticoagulant Discontinuation and Prognosis After Successful Catheter Ablation for Atrial Fibrillation
Authors' conclusion
OAC discontinuation at 8.1 months post ablation may represent the optimal timing for a balance between thromboembolic and bleeding risks in this cohort. Individualized risk assessment facilitates OAC management after successful ablation.
Study context
- Population
- Patients who underwent initial atrial fibrillation ablation between 2006 and 2022patients who underwent initial atrial fibrillation ablation
- Participants
- 2,448 patients
- Comparison
- patients who discontinued oral anticoagulants (OACs) and those who continued across various time points following successful ablation
Methodological detailsinverse probability of treatment weighting analysis, landmark period (1-537 weeks after ablation)
- Inverse probability of treatment weighting analysis
- Landmark period (1-537 weeks after ablation)
Main finding
As reported in the abstract
Thromboembolic and major bleeding events · median follow-up period of 34.1 months (Q1-Q3: 12.4-81.9 months)
Thromboembolic events
66 (2.7%) (0.63 per 100 patient-years)
Major bleeding events
62 patients (2.5%) (0.59 per 100 patient-years)
Further findings
| Outcome | HR | P value |
|---|---|---|
| Thromboembolic risk, bleeding risk and mortality · 8.1 months — OAC discontinuation vs those who continued · thromboembolic risk (high) | 2.364 | P = 0.010 |
| Thromboembolic risk, bleeding risk and mortality · 8.1 months — OAC discontinuation vs those who continued · bleeding risk (reduced) | 0.176 | P = 0.002 |
| Thromboembolic risk, bleeding risk and mortality · 8.1 months — OAC discontinuation vs those who continued · mortality (no significant difference) | 0.925 | P = 0.830 |
Estimated thromboembolic and bleeding risk of OAC discontinuation over time
- Thromboembolic risk of OAC discontinuation increased at 4-5 months post ablation
- Bleeding risk gradually decreased alongside the prolonged discontinuation timing
Reverse net clinical benefit
- Peaked at
- 8.1 months
- Suggesting this was the optimal discontinuation timing
Original publication
Optimal Timing for Oral Anticoagulant Discontinuation and Prognosis After Successful Catheter Ablation for Atrial Fibrillation. JACC Clin Electrophysiol. Published 2 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it