TOPLINE

Continuing oral anticoagulation (OAC) after atrial fibrillation (AF) ablation was not associated with reduced stroke or transient ischemic attack (TIA) risk overall and increased the risk for major bleeding. However, in high-risk patients with CHA2DS2-VASc scores ≥2, continuing OACs was associated with a significantly lower risk for stroke/TIA.

METHODOLOGY

• Researchers conducted a meta-analysis of 31 studies (3 randomized controlled trials, 17 prospective cohort studies, and 11 retrospective studies) published through November 2025.
• The analysis included 50,327 patients with AF, of whom 31,509 continued OAC and 18,818 discontinued OACs after the postablation blanking period. Most studies (25 of 31) applied a 3-month blanking period, and follow-ups ranged from 1 to 4 years.
• Studies originated from diverse geographic regions: 12 from Asia, 13 from North America, 6 from Europe, and 1 from South America, published between 2006 and 2025.
• Primary outcomes included stroke/TIA, major bleeding, major adverse cardiovascular events, and all-cause mortality; secondary outcomes included specific bleeding and blood clot event subtypes.
• Meta-regression analyses examined study-level covariates, including mean age, BMI, prevalence of vascular disease, left ventricular ejection fraction, left atrial diameter, mean CHA2DS2-VASc score, mean HAS-BLED score, and total sample size.

TAKEAWAY

• Overall, continuing OACs was not associated with reduction in the risk for stroke/TIA risk (odds ratio [OR], 1.48; P = .16).
• In patients with CHA2DS2-VASc scores ≥2, continuing OACs was associated with a significantly lower risk for stroke/TIA (OR, 0.42; P = .04).
• In studies with well-balanced baseline CHA2DS2-VASc scores between groups, continuing blood thinners was associated with a significantly lower stroke/TIA risk (OR, 0.50; P < .01).
• Continuing blood thinners was associated with a significantly higher risk of major bleeding (OR, 4.62; P < .01), including increased risks of hemorrhagic stroke (OR, 3.96; P = .03), intracranial hemorrhage (OR, 4.62; P = .03), and gastrointestinal bleeding (OR, 4.72; P < .01).

IN PRACTICE

"In patients with CHA2DS2-VASc scores ≥2, particularly when baseline risk is well-balanced between groups, continuation of blood thinners after AF ablation is associated with a significantly lower risk of stroke/TIA," wrote the authors of the study.

SOURCE

The study was led by Sandeep Samethadka Nayak, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, 267 Grant St, Bridgeport, Connecticut. It was published online on July 8 in Europace.

LIMITATIONS

High heterogeneity was observed across multiple outcomes. The predominance of observational studies might have introduced inherent selection bias. Many studies either did not report baseline stroke scores or showed significant between-group differences, limiting comparability. Adherence and persistence with blood thinners were not systematically addressed across studies.

DISCLOSURES

The authors did not declare any funding sources or relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.