- Question
- In patients with no documented atrial arrhythmia recurrence after catheter ablation for atrial fibrillation (AF), is discontinuing oral anticoagulation superior to continuing it?
- Design
- Open-label (no masking) 1:1 randomized clinical trial of 840 patients enrolled at 18 hospitals in South Korea between 2020 and 2023; the main follow-up was 2 years.
- Population
- Adults aged 19 to 80 years with at least one non-sex-related stroke risk factor (per CHA2DS2-VASc) and no documented atrial arrhythmia recurrence for at least 1 year after ablation. Mean age was 64 years, 24.9% were women, and 67.6% had paroxysmal AF.
- Intervention
- Discontinuation of oral anticoagulant therapy (n = 417).
- Control
- Continuation of oral anticoagulation with a direct oral anticoagulant (n = 423); per the registry, apixaban 5 mg twice daily (2.5 mg if dose-reduction criteria were met).
- Primary outcome
- First occurrence of the composite of stroke, systemic embolism, and major bleeding at 2 years.
- Results
- The primary outcome occurred in 1 patient (0.3%) in the discontinuation group vs 8 patients (2.2%) in the continuation group (absolute difference -1.9 percentage points; 95% CI -3.5 to -0.3; P = .02). The 2-year cumulative incidence of ischemic stroke was 0.3% vs 0.8% (difference -0.5 percentage points; 95% CI -1.6 to 0.6).
- Safety
- Major bleeding occurred in 0 patients in the discontinuation group vs 5 patients (1.4%) in the continuation group (absolute difference -1.4 percentage points; 95% CI -2.6 to -0.2).
- Conclusion
- Among patients without documented recurrence after AF ablation, discontinuing anticoagulation lowered the risk of the composite of stroke, systemic embolism, and major bleeding compared with continuing it.
- Why it matters
- It provided randomized evidence on a question that previously lacked it and challenges indefinite anticoagulation based on risk score alone in patients without recurrence after ablation, although it is an open-label trial with few events.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026