Real-world investigation on discontinuation of oral anticoagulation after paroxysmal atrial fibrillation catheter ablation in China

Abstract

Background: To find out the real-world investigation on discontinuation of oral anticoagulation after paroxysmal atrial fibrillation (AF) catheter ablation China. Methods:We enrolled in our study 1,508 consecutive paroxysmal AF patients who underwent catheter ablation from five centers. Patients' clinical data and follow-up data were collected. Clinical data included on-admission characteristics such as gender, age, type and duration of AF, type of ablation, ablation sessions, history of diseases, CHA 2 DS 2 -VASc score, echocardiographic variables, medication, and blood test variables.Follow-up data included duration of follow-up, the status of oral anticoagulant (OAC) therapy, adverse events, and recurrence of AF.Results: A total of 1,491 patients were included in the final analysis, while the other 17 patients lost contact. The follow-up duration was 12 to 74 months (27.8±14.6 months). Of 1,491 patients, 989 (66.3%) patients stopped OAC therapy 3 to 14 months after successful ablation during follow-up. Stroke or transient ischemic attack (TIA) occurred in 37 (2.5%) patients. Major bleeding occurred in 24 (1.6%) patients. Six (0.4%) patients died at follow-up. Patients who stopped OAC had lower CHA2DS2-VASc score (1.5±1.4 vs. 2.4±1.7, P<0.05) and lower incidence of major bleeding (11/989 vs. 13/502, P<0.05). Of 989 patients who stopped OAC, 318 stopped according to doctor's prescription, and 671 stopped on their own decision.In patients who underwent brain MRI, patients who stopped OAC had a lower incidence of silent cerebral infarction (SCI) (37/904 vs. 38/419, P<0.05). Among patients who did not stop warfarin therapy, there were 117 (117/397, 29.5%) patients had not to achieve target INR. Conclusions:The incidence of adverse events was relatively low in paroxysmal AF patients who stopped OAC. The patient partly determined when OAC was discontinued. Target INR was not achieved in many patients who had not to stop OAC.

Discontinuation of oral anticoagulation therapy after successful atrial fibrillation ablation: A systematic review and meta-analysis of prospective studies

“…After a review of titles and abstracts, 2,472 studies were excluded, and the remaining 32 were considered potentially eligible trials and identified by reading the full-text. Finally, a total of 10 studies [12][13][14][15][16][17][18][19][20][21] were included. After screening the reference lists of included articles, we retrieved two potential studies, but neither met our inclusion criteria.…”

“…These studies were published between 2006 and 2020. Among the ten studies included here, four were conducted in the United States [12][13][14]16], two in China [19,20], one in the UK and Australia [21], one in France [18], and one in Italy [17]. The sample size ranged from 108 [16] to 4512 [19] patients.…”

“…The duration of followup across the studies ranged from 1.9 to 5 years. Warfarin as the only anticoagulant drug was prescribed for patients in all but four studies [16,[18][19][20], which included partial patients on direct OACs (DOACs). OAC was discontinued in 7,160 (64.2%) patients.…”

“…The time frame of discontinuation of OAC ranged from 2 to 12 months. In nine studies collectively [12][13][14][15][16][18][19][20][21], 2488 patients (24.0%) developed AF recurrence. In six studies [13, 15-17, 19, 21], OAC was switched to antiplatelet agents in the majority of off-OAC patients.…”

“…Two studies [17,19] stratified patients according to the CHA 2 DS 2 -VAS c score and reported corresponding clinical outcomes in the two groups. Nine studies [12][13][14][15][16][17][18][19][20] were assessed to be high quality according to the NOS score (range 7 to 9). The results of the quality assessment are described in S2 Table.…”