University of Oklahoma Health Sciences Center

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Author/s:

Mark S. Link

Date Added:

December 11, 2025

Journal/Publication:

New England Journal of Medicine

Publication Date:

December 1, 2025

URL:

Should We Continue Anticoagulation Indefinitely after Catheter Ablation of Atrial Fibrillation?

Type:

Clinical Research Results

Keywords

anticoagulants

Ablation

atrial fibrillation

MeSH

anticoagulants

ablation

atrial fibrillation

RPR Commentary

It is reasonable to stop anticoagulants post successful ablation if there has been no reoccurrence of atrial fibrillation for 1 year or more. James W. Mold, MD, MPH

Abstract

Context
Current guidelines recommend indefinite anticoagulation after ablation of atrial fibrillation (AF) in patients with a CHA2DS2-VASc score ≥2–3, but few data support this practice. In a recent randomized trial (ALONE-AF), stopping anticoagulation 1 year after ablation did not raise stroke risk; now, another trial (OCEAN) has examined the same issue.

Researchers randomized 1300 patients with successful catheter ablation (no AF at 1 year clinically or on Holter monitoring) to receive rivaroxaban 15 mg or low-dose aspirin. Exclusion criteria included severe renal disease, hypercoagulability, and age >85. The mean CHA2DS2-VASc score was 2.2; only 10% of patients had scores ≥4.

Key Results
At 3 years, the incidence of the composite outcome (stroke, systemic embolism, or new covert stroke on MRI) did not differ significantly between treatment groups (0.8% with rivaroxaban and 1.4% with aspirin).
Major bleeding occurred slightly more often with rivaroxaban than with aspirin (1.6% and 0.6%), but this did not reach significance.