Abstract
Background and aims
The safety of suspending oral anticoagulation (OAC) after successful atrial fibrillation (AF) catheter ablation remains unclear, and prior studies have not stratified outcomes by CHA₂DS₂-VASc score. This meta-analysis evaluates thromboembolic and hemorrhagic cerebrovascular events in patients with interrupted versus uninterrupted OAC following ablation.
Methods
A comprehensive search of electronic databases through December 2025 identified studies comparing interrupted versus uninterrupted OAC after successful AF ablation, including vitamin K antagonists and direct oral anticoagulants. One non-randomized controlled trial, eight retrospective cohort studies (two with propensity score matching), and two prospective cohort studies were included. Outcomes included thromboembolic and hemorrhagic events stratified by CHA₂DS₂-VASc scores ≤1 and ≥2.
Results
Among 128,144 patients with AF after ablation (62,224 uninterrupted; 65,920 interrupted; 11 studies), no significant difference in thromboembolic events was observed between groups: CHA₂DS₂-VASc ≤1 (RR 0.87, 95%CI 0.51–1.48, p=0.61) and CHA₂DS₂-VASc ≥2 (RR 1.12, 95%CI 0.82–1.52, p=0.49). Interrupted OAC was associated with a significant reduction in hemorrhagic events in both risk strata: CHA₂DS₂-VASc ≤1 (RR 0.18, 95%CI 0.06–0.61, p=0.006) and CHA₂DS₂-VASc ≥2 (RR 0.27, 95%CI 0.09–0.78, p=0.02).
Conclusions
Interruption of OAC after successful AF ablation appears safe across CHA₂DS₂-VASc strata, with reduced hemorrhagic risk and no increase in thromboembolic events. These findings question routine post-ablation OAC continuation and warrant confirmation in randomized controlled trials.
Conflict of interest
Amiel Armando Aragon Cortes. Nothing to disclose
Figure 1 - belongs to Results
Figure 2 - belongs to Conclusions
Figure 3 - belongs to Conclusions
