Arrhythmias & electrophysiologyCohort study
Post-AF ablation anticoagulation: Real-world practice and predictors of therapy
- Retrospective claims database study
- automated machine learning prediction
Authors' conclusion
Discordant with guidelines recommendations, OAC discontinuation was common among patients with AF and at least moderate stroke risk. Stroke risk, left atrial appendage occlusion, and bleeding experience were the strongest determinants of OAC discontinuation but did not explain much of the discontinuation.
Study context
- Population
- Patients with atrial fibrillation (AF) who underwent catheter ablation (CA) from January 1, 2017 to October 1, 2023, identified from Optum's Clinformatics® Data Martpatients included
- Participants
- 65,020 patients
Main finding
As reported in the abstract
mean age
69
female
39%
mean CHA2DS2-VASc score
4.16 ± 2.03
Observational data: associations, not effects.
Further findings
Oral anticoagulation (OAC) continuation · over the year after CA
- OAC continuation fell steadily over the year after CA, especially among lower risk patients
OAC not prescribed at the time of ablation or after
- patients across all risk groups
- approximately 10%-20%
Prediction of OAC use within 1 year after CA (area under the receiver operating curve)
- area under the receiver operating curve, total AF population
- 0.607 (95% confidence interval, 0.587-0.614)
Main predictors for OAC discontinuation at 1 year
- lower CHA2DS2-VASc baseline score
- w, 0.033
- left atrial appendage occlusion after CA
- w, 0.018
- bleeding event in the follow-up period
- w, 0.010
Original publication
Summarised from the published abstract; every number is checked against it