Should We Continue Anticoagulation Indefinitely after Catheter Ablation of Atrial Fibrillation?
Abstract
Context
Current guidelines recommend indefinite anticoagulation after ablation of atrial fibrillation (AF) in patients with a CHA2DS2-VASc score ≥2–3, but few data support this practice. In a recent randomized trial (ALONE-AF), stopping anticoagulation 1 year after ablation did not raise stroke risk; now, another trial (OCEAN) has examined the same issue.
Researchers randomized 1300 patients with successful catheter ablation (no AF at 1 year clinically or on Holter monitoring) to receive rivaroxaban 15 mg or low-dose aspirin. Exclusion criteria included severe renal disease, hypercoagulability, and age >85. The mean CHA2DS2-VASc score was 2.2; only 10% of patients had scores ≥4.
Key Results
At 3 years, the incidence of the composite outcome (stroke, systemic embolism, or new covert stroke on MRI) did not differ significantly between treatment groups (0.8% with rivaroxaban and 1.4% with aspirin).
Major bleeding occurred slightly more often with rivaroxaban than with aspirin (1.6% and 0.6%), but this did not reach significance.
RPR Commentary
It is reasonable to stop anticoagulants post successful ablation if there has been no reoccurrence of atrial fibrillation for 1 year or more. James W. Mold, MD, MPH