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Item refines Peer-reviewed Added

Oral anticoagulation after AF ablation raised bleeding without fewer ischaemic strokes

In 280,415 patients, continuing anticoagulation after AF ablation left ischaemic stroke unchanged but roughly tripled bleeding odds.

This systematic review and meta-analysis compared continuing versus stopping oral anticoagulation after catheter ablation for atrial fibrillation. It pooled 3 randomised trials and 35 cohort studies, covering 280,415 patients followed for 2.7 years. Net clinical benefit (NCB) weighed ischaemic strokes prevented against intracranial haemorrhages caused, counting each haemorrhage as 1.5 strokes. Pooled, continued anticoagulation left ischaemic stroke similar but raised major bleeding (OR 2.93) and intracranial haemorrhage (OR 3.63). NCB favoured stopping (-0.46; 95% CI -0.77 to -0.14), a negative score meaning net harm from continuing. The trials alone showed no difference on any outcome, so the harm signal rests on observational cohorts.

Why it is interesting: Anticoagulation after ablation shapes both stroke and bleeding rates in people with atrial fibrillation. The pooled evidence suggests its stroke benefit shrinks after ablation while its bleeding cost remains.

Source
Thrombosis and Haemostasis, 2 November 2026
Paper
Net Clinical Benefit of Continuing vs Discontinuing Anticoagulation After Atrial Fibrillation Ablation: Results from a 280,000-Patient Meta-Analysis
Authors
Koolaji S, Gorog DA, Leader JH, Markides V
DOI
10.1055/a-2994-8900
Type
Peer-reviewed article
Design
Systematic review and meta-analysis of 38 studies (3 RCTs, 35 cohorts), 280,415 patients, mean 2.7 years' follow-up
Verdict
Refines prior evidence
Driver
Heart and stroke

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