Heart rhythm · 2026
Can oral anticoagulants be safely discontinued after atrial fibrillation ablation? A systematic review and meta-analysis of reconstructed time-to-event data.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Barbosa Lucas M, Oliveira Vinícius Martins Rodrigues, Rivera André, Araújo Beatriz, Cabral David Curi Barbosa Izoton, Consoli Leo N, Defante Maria L R, Queiroz Ivo, Tartuce Ludimilla Pereira, Nunes Maria do Carmo P, Nascimento Bruno R, Guimarães Patrícia O, Moreira Humberto Graner, Lip Gregory Y H, Bhatt Deepak L
Аннотация
BACKGROUND: Ablation procedures are frequently used to restore sinus rhythm in atrial fibrillation (AF), given the increased stroke risk associated with AF. The decision to discontinue oral anticoagulation (OAC) therapy postprocedure requires careful consideration of stroke and bleeding risks, especially because of the absence of definitive guidelines.
OBJECTIVE: This meta-analysis aims to evaluate the implications of OAC discontinuation after catheter ablation for AF, focusing on thromboembolic events (TEs) and bleeding events.
METHODS: A systematic search was conducted in 4 databases for studies comparing OAC discontinuation with maintenance in patients with AF postablation. We pooled odds ratios (ORs) for binary outcomes with a random effects model and performed sensitivity analyses using hazard ratios and subgroups based on CHA2DS2-VASc scores and sinus rhythm status.
RESULTS: 32 studies were included, comprising 271,808 patients, with 88,164 (32.4%) discontinuing OAC use after ablation. The primary analysis showed no significant differences in TE incidence (OR 0.90; 95% confidence interval 0.68-1.20; P = .47) or mortality (OR 0.85; 95% confidence interval 0.67-1.08; P = .19). However, OAC discontinuation was significantly associated with reduced major bleeding events (OR 0.35; P < .01). For patients with a CHA2DS2-VASc score >2, discontinuing OAC significantly increased TE risk. For patients with CHA2DS2-VASc scores 0-2 and those sustaining sinus rhythm, the results were consistent with the overall analysis.
CONCLUSION: Discontinuation of OACs in patients with AF postablation did not significantly affect the overall TE incidence but was associated with a notable reduction in major bleeding events. However, there was a significant increase in TE risk in patients with a CHA2DS2-VASc score >2 upon discontinuation.
OBJECTIVE: This meta-analysis aims to evaluate the implications of OAC discontinuation after catheter ablation for AF, focusing on thromboembolic events (TEs) and bleeding events.
METHODS: A systematic search was conducted in 4 databases for studies comparing OAC discontinuation with maintenance in patients with AF postablation. We pooled odds ratios (ORs) for binary outcomes with a random effects model and performed sensitivity analyses using hazard ratios and subgroups based on CHA2DS2-VASc scores and sinus rhythm status.
RESULTS: 32 studies were included, comprising 271,808 patients, with 88,164 (32.4%) discontinuing OAC use after ablation. The primary analysis showed no significant differences in TE incidence (OR 0.90; 95% confidence interval 0.68-1.20; P = .47) or mortality (OR 0.85; 95% confidence interval 0.67-1.08; P = .19). However, OAC discontinuation was significantly associated with reduced major bleeding events (OR 0.35; P < .01). For patients with a CHA2DS2-VASc score >2, discontinuing OAC significantly increased TE risk. For patients with CHA2DS2-VASc scores 0-2 and those sustaining sinus rhythm, the results were consistent with the overall analysis.
CONCLUSION: Discontinuation of OACs in patients with AF postablation did not significantly affect the overall TE incidence but was associated with a notable reduction in major bleeding events. However, there was a significant increase in TE risk in patients with a CHA2DS2-VASc score >2 upon discontinuation.