Arrhythmias & electrophysiologyResearch article
Optimal Timing for Oral Anticoagulant Discontinuation and Prognosis After Successful Catheter Ablation for Atrial Fibrillation
- retrospectively analyzed
- inverse probability of treatment weighting analysis
- landmark period (1-537 weeks after ablation)
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
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:10.1016/j.jacep.2026.02.027
Summarised from the published abstract; every number is checked against it