Discontinuing Anticoagulation after Atrial Fibrillation Ablation: Has the Evidence Really Changed?
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Abstract
Referring to: Nayak SS et al. Clinical outcomes of continuing vs discontinuing oral anticoagulation after atrial fibrillation ablation: an updated systematic review and meta-analysis of observational studies and randomized controlled trials. Atrial fibrillation (AF) is one of the most commonly encountered heart conditions, and its prevalence is increasing as the population ages. Beyond its symptomatic burden, AF is associated with serious complications, of which thromboembolism is probably the most significant one. Generally, antithrombotic therapy decisions require careful assessment of thrombotic versus bleeding risks. In AF, these risks often arise from overlapping factors, including age, hypertension, prior stroke, vascular disease, and renal impairment, which contribute to both CHA₂DS₂-VA and HAS-BLED scores. According to the latest guidelines, anticoagulation should be considered in patients with AF and a CHA2DS2-VA score of 1 (class IIa) and is recommended in patients with ≥2 scores (class I).
1. Nayak SS, Amini-Salehi E, Letafatkar N, Arya A, Ghodous S, Jafari M, et al. Clinical outcomes of continuing vs discontinuing oral anticoagulation after atrial fibrillation ablation: an updated systematic review and meta-analysis of observational studies and randomised controlled trials. Europace. 2026;28(7):euag104.
2. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS. Eur Heart J. 2024;45(36):3314-414.
3. Font J, Dolladille C, Legallois D, Al Khoury M, Champ-Rigot L, Chaumont C, et al. Temporal trends in atrial fibrillation catheter ablation efficacy: a systematic review, meta-analysis and meta-regression from more than 20 years of clinical data. Arch Cardiovasc Dis. 2026;119(2):154-61.
4. Potpara T, Grbovic Markovic B, Grygier M, Genovesi S, Tzikas A, Boveda S, et al. Adherence to oral thromboprophylaxis in atrial fibrillation: an overview for clinicians. Europace. 2025;27(11):euaf250.
5. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-62.
6. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e167.
7. Go AS, Reynolds K, Yang J, Gupta N, Lenane J, Sung SH, et al. Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: the KP-RHYTHM study. JAMA Cardiol. 2018;3(7):601-8.
8. Healey JS, Lopes RD, Granger CB, Alings M, Rivard L, McIntyre WF, et al. Apixaban for stroke prevention in subclinical atrial fibrillation. N Engl J Med. 2024;390(2):107-17.
9. Kirchhof P, Toennis T, Goette A, Camm AJ, Diener HC, Becher N, et al. Anticoagulation with edoxaban in patients with atrial high-rate episodes. N Engl J Med. 2023;389(13):1167-79.
10. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterisation, and clinical implication. Europace. 2016;18(10):1455-90.
11. Kamel H, Longstreth WT Jr, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, et al. Apixaban to prevent recurrence after cryptogenic stroke in patients with atrial cardiopathy: the ARCADIA randomised clinical trial. JAMA. 2024;331(7):573-81.
12. Andrade JG, Champagne J, Dubuc M, Deyell MW, Verma A, Macle L, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomised clinical trial (CIRCA-DOSE). Circulation. 2019;140(22):1779-88.
13. Verma A, Birnie DH, Jiang C, Heidbüchel H, Hindricks G, Kirchhof P, et al. Antithrombotic therapy after successful catheter ablation for atrial fibrillation. 2026;394(4):323-32.
14. Kim D, Shim J, Choi EK, Oh IY, Kim J, Lee YS, et al. Long-term anticoagulation discontinuation after catheter ablation for atrial fibrillation: the ALONE-AF randomized clinical trial. JAMA.2025;334(14):1246-54.
15. Kim D, Lee YS, Shim J, Yu HT, Park J, Park JK, et al. Anticoagulation for atrial fibrillation with intermediate stroke risk. N Engl J Med. 2026;395(12):1155-65.
2. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS. Eur Heart J. 2024;45(36):3314-414.
3. Font J, Dolladille C, Legallois D, Al Khoury M, Champ-Rigot L, Chaumont C, et al. Temporal trends in atrial fibrillation catheter ablation efficacy: a systematic review, meta-analysis and meta-regression from more than 20 years of clinical data. Arch Cardiovasc Dis. 2026;119(2):154-61.
4. Potpara T, Grbovic Markovic B, Grygier M, Genovesi S, Tzikas A, Boveda S, et al. Adherence to oral thromboprophylaxis in atrial fibrillation: an overview for clinicians. Europace. 2025;27(11):euaf250.
5. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-62.
6. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e167.
7. Go AS, Reynolds K, Yang J, Gupta N, Lenane J, Sung SH, et al. Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: the KP-RHYTHM study. JAMA Cardiol. 2018;3(7):601-8.
8. Healey JS, Lopes RD, Granger CB, Alings M, Rivard L, McIntyre WF, et al. Apixaban for stroke prevention in subclinical atrial fibrillation. N Engl J Med. 2024;390(2):107-17.
9. Kirchhof P, Toennis T, Goette A, Camm AJ, Diener HC, Becher N, et al. Anticoagulation with edoxaban in patients with atrial high-rate episodes. N Engl J Med. 2023;389(13):1167-79.
10. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterisation, and clinical implication. Europace. 2016;18(10):1455-90.
11. Kamel H, Longstreth WT Jr, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, et al. Apixaban to prevent recurrence after cryptogenic stroke in patients with atrial cardiopathy: the ARCADIA randomised clinical trial. JAMA. 2024;331(7):573-81.
12. Andrade JG, Champagne J, Dubuc M, Deyell MW, Verma A, Macle L, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomised clinical trial (CIRCA-DOSE). Circulation. 2019;140(22):1779-88.
13. Verma A, Birnie DH, Jiang C, Heidbüchel H, Hindricks G, Kirchhof P, et al. Antithrombotic therapy after successful catheter ablation for atrial fibrillation. 2026;394(4):323-32.
14. Kim D, Shim J, Choi EK, Oh IY, Kim J, Lee YS, et al. Long-term anticoagulation discontinuation after catheter ablation for atrial fibrillation: the ALONE-AF randomized clinical trial. JAMA.2025;334(14):1246-54.
15. Kim D, Lee YS, Shim J, Yu HT, Park J, Park JK, et al. Anticoagulation for atrial fibrillation with intermediate stroke risk. N Engl J Med. 2026;395(12):1155-65.
| Files | ||
| Issue | Vol 21 No 4 (2026) | |
| Section | Editorial | |
| DOI | https://doi.org/10.18502/rhythm.v21i4.23088 | |
| Keywords | ||
| Atrial Fibrillation Catheter Ablation Oral Anticoagulation Stroke Major Bleeding Atrial Cardiomyopathy | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Shahi S, Zarbini Seydani A, Mohammadi S. Discontinuing Anticoagulation after Atrial Fibrillation Ablation: Has the Evidence Really Changed?. Res Heart Yield Transl Med. 2026;21(4):259-262.
