Arrhythmias & electrophysiologyCohort study
Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks
- Retrospective cohort study
- Japanese nationwide administrative claims database
- inverse probability of treatment weighting
- 6-month landmark
Authors' conclusion
This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient's CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk.
Study context
- Population
- Patients who underwent catheter ablation (CA) for atrial fibrillation (AF), without AF recurrence, Japan, April 2014–March 202171% continued oral anticoagulant (OAC)
- Participants
- 231,374 patients
- Exposure
- Continued OAC vs no continued OAC 6 months after AF catheter ablation
- Outcome
- Thromboembolism and major bleeding, by CHADS2 score
- Follow-up
- After a landmark period of 6 months
Main finding
As reported in the abstract
Thromboembolism, by CHADS2 score
Continued OAC vs No continued OACHazard ratio (95% CI)P value
CHADS2 ≤1
0.86(0.74–1.01)
P = 0.06CHADS2 ≥3
0.61(0.46–0.82)
P = 0.001- Thromboembolism, all patients
- 2451 (0.55 per 100 person-years)
Observational data: associations, not effects.
Further findings
OAC continuation by CHADS2 score · 6 months
- OAC continuation rate higher in high than in low CHADS2 score group
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding, by CHADS2 score — Continued OAC vs No continued OAC · CHADS2 ≤1 · inverse probability of treatment weighting | 1.51 (1.27–1.80) | P < 0.001 | |
| Major bleeding, by CHADS2 score — Continued OAC vs No continued OAC · CHADS2 ≥3 · inverse probability of treatment weighting | 1.05 (0.71–1.56) | P = 0.81 | |
| 0.512Hazard ratio (log scale) |
- Major bleeding, by CHADS2 score — Major bleeding, all patients
- 2367 (0.53 per 100 person-years)
Original publication
Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks. Eur Heart J. Published 20 December 2023. doi:10.1093/eurheartj/ehad798
Summarised from the published abstract; every number is checked against it