Clinical outcomes of continuing vs. discontinuing oral anticoagulation after atrial fibrillation ablation: an updated systematic review and meta-analysis of observational studies and randomized controlled trials

Continuation of oral anticoagulation (OAC) after successful atrial fibrillation (AF) ablation remains debated. With recent randomized controlled trials addressing this question, an updated meta-analysis is needed to inform clinical decision-making.

A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was performed through 24 November 2025, to identify studies comparing clinical outcomes in patients who continued vs. discontinued OAC after AF catheter ablation. Overall, continuing OAC was not significantly associated with the risk of stroke/TIA (OR: 1.48, 95% CI: 0.84–2.60; P = 0.16). However, when stratified by CHA₂DS₂-VASc score, patients with scores ≥2 had a significantly lower risk of stroke/TIA with OAC continuation (OR: 0.42, 95% CI: 0.18–0.95; P = 0.04). This protective effect was further supported in studies with well-balanced baseline risk between groups, where OAC continuation was associated with a significantly lower risk of stroke/TIA (OR: 0.50, 95% CI: 0.34–0.72; P < 0.01). Conversely, OAC continuation significantly increased the risk of major bleeding. No significant association was observed for major adverse cardiac events or all-cause mortality.

In patients with CHA₂DS₂-VASc scores ≥2, particularly when baseline risk is well-balanced between groups, continuation of OAC after AF ablation is associated with a significantly lower risk of stroke/TIA. These findings support continuing OAC in higher-risk patients (CHA₂DS₂-VASc ≥2). However, given the significantly increased risk of major bleeding associated with OAC continuation, the decision to continue anticoagulation in lower-risk patients requires careful consideration, as no clear thromboembolic benefit was observed in this population.