Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS2 score 0-2 points after catheter ablation for persistent atrial fibrillation.

Abstract

Background: Guidelines state that oral anticoagulants (OACs) should be continued after catheter ablation for atrial fibrillation (AF) based on thromboembolic risk stratification, regardless of procedural results. However, whether OACs could be discontinued in low-thromboembolic-risk patients remains unclear.

Methods: This was a retrospective follow-up study from the EARNEST-PVI (NCT03514693) trial, which compared the efficacy of pulmonary vein isolation (PVI)-alone and PVI-plus strategies for persistent AF ablation. A total of 427 patients with CHADS₂ score of ≤2 points were divided into two groups: OAC continuation throughout the overall period (group C, n = 205) and OAC discontinuation within 1 year after ablation (group D, n = 222). The incidence of thromboembolic and bleeding events was analyzed.

Results: AF recurrence (33 % vs. 17 %, p < 0.001), thromboembolic events (1.39 % vs. 0 % per year, p = 0.005), and overall bleeding event rates (7.54 % vs. 3.32 % per year, p = 0.003) were higher in group C than in group D. There was no significant difference in major bleeding event rates between the C and D groups (0.51 % vs. 0.67 % per year, p = 0.686). However, a higher number of overall bleeding events, including major and clinically relevant non-major events, was observed in group C (adjusted hazards ratio: 2.04, 95 % confidence interval: 1.14-3.65, p = 0.016).

Conclusions: Thromboembolic events and overall bleeding events were fewer in the OAC discontinuation group compared with the OAC continuation group. Discontinuation of OACs might be considered in patients with low CHADS₂ score after catheter ablation of persistent AF.