Work

Discontinuation of oral anticoagulants is common after catheter ablation in older patients with atrial fibrillation

Year: 2026

Type: article

Abstract: Aims Guidelines recommend continuing oral anticoagulation (OAC) after atrial fibrillation (AF) ablation based on stroke risk, yet real-world post-procedural OAC management remains poorly characterized. We aimed to evaluate contemporary patterns of OAC use after AF ablation and identify predictors of OAC discontinuation. Methods and results Using Medicare claims from 2013–2022, we established a cohort of patients undergoing a first AF ablation and assessed patterns of OAC discontinuation during the subsequent year. We defined OAC discontinuation as a dispensing gap ≥60 days. Baseline characteristics were evaluated as predictors of discontinuation using least absolute shrinkage and selection operator Cox regression. Among 208 232 AF patients (mean age 74.5, 47% women) undergoing ablation, 58% were taking OAC following ablation, 24% discontinued between 3 and 12 months, 8% discontinued within 3 months, and 10% did not use OAC within 3 months. Apixaban was the most commonly used OAC agent, while the use of warfarin declined over time. The overall rate of repeated ablation was 26%. We found that 44% of patients with CHA2DS2-VASc score ≥3 discontinued OAC within 1 year after ablation. Higher CHA2DS2-VASc scores and longer pre-ablation OAC use were associated with lower discontinuation, whereas pre-ablation major bleeding, frailty, and use of warfarin (vs. direct OACs) increased the likelihood of discontinuation. Conclusion OAC discontinuation after AF ablation is common, including among patients at elevated stroke risk despite guideline recommendations for continued therapy. More data are needed on the clinical consequences of post-ablation OAC discontinuation.

Source: European Heart Journal Open

DOI: 10.1093/ehjopen/oeag128

Authors: Xiaojuan Liu, Daniel E Singer, E Kevin Heist, Kueiyu Joshua Lin

Institutions: Brigham and Women's Hospital, Massachusetts General Hospital

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,673