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Arrhythmias & electrophysiologyCohort study

Residual thromboembolic risk and outcomes of oral anticoagulation discontinuation after atrial fibrillation ablation: a target trial emulation

EuropacePublished

  • Target trial emulation (multicentre prospective registry)
  • inverse probability weighting
  • 6-month landmark
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Authors' conclusion

Among patients without prior thromboembolism who remained arrhythmia-free at 6 months after AF ablation, OAC discontinuation was not associated with a difference in the composite outcome of stroke, systemic embolism and major bleeding compared with OAC continuation. Residual risk remained low in patients with CHA2DS2-VA scores 2-3 but exceeded conventional thresholds in those with scores ≥4.

Study context

Population
Patients with CHA2DS2-VA ≥2, no prior thromboembolism and no atrial arrhythmia recurrence within 6 months after atrial fibrillation (AF) ablation, China
Participants
8,339 patients
Exposure
Oral anticoagulation (OAC) discontinuation vs continuation after AF ablation
  • Discontinuedn = 4,406
  • Continuedn = 3,933reference
Outcome
Composite of:
  • Stroke
  • Systemic embolism
  • Major bleeding

Main finding

Stroke, systemic embolism and major bleeding

Weighted hazard ratio

0.93

95% CI 0.67–1.29

Discontinued vs Continued
weighted HR 0.93 (95% CI 0.67–1.29)

As reported in the abstract

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
Clinically relevant non-major bleeding · less frequent after OAC discontinuation0.68 (0.47–0.97)

Thromboembolism

Thromboembolic risk similarly comparable between groups
0.69-1.35 (HR 0.96; 95% CI)

Annualized thromboembolic rate after discontinuation, by CHA2DS2-VA score

CHA2DS2-VA scores 2-3
<1%
CHA2DS2-VA scores ≥4
1.52%

Sensitivity analyses

Findings consistent in sensitivity analyses

Safety

OutcomeHR (95% CI)
Clinically relevant non-major bleeding · less frequent after discontinuation0.68 (0.47–0.97)

Original publication

Residual thromboembolic risk and outcomes of oral anticoagulation discontinuation after atrial fibrillation ablation: a target trial emulation. Europace. Published 4 August 2026. doi:10.1093/europace/euag197
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Summarised from the published abstract; every number is checked against it