{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:18:16Z","timestamp":1790716696515,"version":"4.1.0"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82370383"],"award-info":[{"award-number":["82370383"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003453","name":"Guangdong Natural Science Foundation","doi-asserted-by":"crossref","award":["2024A1515013289"],"award-info":[{"award-number":["2024A1515013289"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Sun Yat-sen University Clinical Research 5010 Program","award":["2017003"],"award-info":[{"award-number":["2017003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Current guidelines recommend indefinite oral anticoagulant (OAC) therapy for atrial fibrillation (AF) patients with stroke risk factors, regardless of catheter ablation (CA) outcomes. However, these recommendations are largely based on nonrandomized evidence, and the long-term anticoagulation strategy for patients after successful CA for AF remains uncertain.<\/jats:p>\n                  <jats:p>To evaluate the efficacy and safety of discontinuing OAC versus continuing OAC in AF with successful CA.<\/jats:p>\n                  <jats:p>We searched PubMed, Embase, and major conference proceedings from inception to November 2025 to identify eligible randomized controlled trials (RCTs). Pooled effect estimates were calculated as risk differences (RDs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <jats:p>A total of 2,324 patients were included across three RCTs, with the mean age ranging from 63 to 67 years, 71.4% were men, and the average CHA2DS2-VASc score was approximately 2. Among patients with successful CA, OAC discontinuation was not associated with a significant increase in the risks of stroke, ischemic stroke, stroke or systemic embolism, transient ischemic attack, and all-cause death. In contrast, continued OAC was associated with significantly higher risks of major bleeding (RD: 1.0%, 95% CI: 0.2\u20131.7), intracranial bleeding (RD: 0.6%, 95 CI: 0.0-1.1), minor bleeding (RD: 2.2%, 95% CI: 0.2\u20134.1), and clinically relevant nonmajor bleeding (RD: 2.5%, 95% CI: 1.2\u20133.9). No statistically significant difference was observed in gastrointestinal bleeding between groups.<\/jats:p>\n                  <jats:p>In patients with AF and moderate baseline stroke risk after successful CA, discontinuation of OAC was associated with a lower risk of bleeding complications and was not associated with a statistically significant increase in thromboembolic events. These findings are primarily applicable to patients with moderate stroke risk and should not be extrapolated to higher-risk populations.<\/jats:p>","DOI":"10.1055\/a-2906-7109","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:14:47Z","timestamp":1783124087000},"source":"Crossref","is-referenced-by-count":1,"title":["Discontinuation of Oral Anticoagulation After Successful Catheter Ablation for Atrial Fibrillation: Meta-Analysis of Randomized Clinical Trials"],"prefix":"10.1055","author":[{"given":"Wulamiding","family":"Kaisaier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yili","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yugang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangui","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wengen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1160\/TH16-11-0876","article-title":"Stroke prevention in atrial fibrillation: past, present and future. Comparing the guidelines and practical decision-making","volume":"117","author":"G Lip","year":"2017","journal-title":"Thromb Haemost"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"100797","DOI":"10.1016\/j.lanepe.2023.100797","article-title":"Atrial fibrillation: stroke prevention","volume":"37","author":"T F Chao","year":"2024","journal-title":"Lancet Reg Health Eur"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"euae043","DOI":"10.1093\/europace\/euae043","article-title":"2024 European Heart Rhythm Association\/Heart Rhythm Society\/Asia Pacific Heart Rhythm Society\/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"26","author":"S Tzeis","year":"2024","journal-title":"Europace"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jacc.2021.06.038","article-title":"Cryoballoon ablation as initial treatment for atrial fibrillation: JACC state-of-the-art review","volume":"78","author":"J G Andrade","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"13","key":"ref5","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1001\/jama.2019.0692","article-title":"Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"D B Mark","year":"2019","journal-title":"JAMA"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"J A Joglar","year":"2024","journal-title":"Circulation"},{"issue":"36","key":"ref7","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"I C Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1001\/jamacardio.2016.4179","article-title":"Assessment of use vs discontinuation of oral anticoagulation after pulmonary vein isolation in patients with atrial fibrillation","volume":"2","author":"S Sj\u00e4lander","year":"2017","journal-title":"JAMA Cardiol"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"e007612","DOI":"10.1161\/CIRCEP.119.007612","article-title":"Outcomes and anticoagulation use after catheter ablation for atrial fibrillation","volume":"12","author":"J V Freeman","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1093\/eurheartj\/ehad798","article-title":"Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks","volume":"45","author":"K Kanaoka","year":"2024","journal-title":"Eur Heart J"},{"issue":"08","key":"ref11","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1007\/s00392-023-02319-9","article-title":"Prevention of cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation: the ODIn-AF trial","volume":"113","author":"J W Schrickel","year":"2024","journal-title":"Clin Res Cardiol"},{"issue":"14","key":"ref12","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1001\/jama.2025.14679","article-title":"Long-term anticoagulation discontinuation after catheter ablation for atrial fibrillation: the ALONE-AF randomized clinical trial","volume":"334","author":"D Kim","year":"2025","journal-title":"JAMA"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1056\/NEJMoa2509688","article-title":"Antithrombotic therapy after successful catheter ablation for atrial fibrillation","volume":"394","author":"A Verma","year":"2026","journal-title":"N Engl J Med"},{"key":"ref14","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024)","author":"J PTTJ Higgins","year":"2024"},{"issue":"71","key":"ref15","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"M J Page","year":"2021","journal-title":"BMJ"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"J AC Sterne","year":"2019","journal-title":"BMJ"},{"issue":"11","key":"ref17","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1016\/j.hrthm.2025.06.023","article-title":"Effect of oral anticoagulant therapy on adverse outcomes in patients with atrial fibrillation after intracranial hemorrhage","volume":"22","author":"W Kaisaier","year":"2025","journal-title":"Heart Rhythm"},{"issue":"11","key":"ref18","doi-asserted-by":"crossref","first-page":"e1086","DOI":"10.1016\/j.hrthm.2025.07.051","article-title":"Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: long-term outcomes from 4 randomized trials","volume":"22","author":"W Kaisaier","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jclinepi.2021.02.012","article-title":"A proposed framework to guide evidence synthesis practice for meta-analysis with zero-events studies","volume":"135","author":"C Xu","year":"2021","journal-title":"J Clin Epidemiol"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13643-023-02217-1","article-title":"Ten circumstances and solutions for finding the sample mean and standard deviation for meta-analysis","volume":"12","author":"K Y Chi","year":"2023","journal-title":"Syst Rev"},{"issue":"7650","key":"ref21","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"G H Guyatt","year":"2008","journal-title":"BMJ"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1053\/j.semtcvs.2021.12.003","article-title":"New oral anticoagulant versus vitamin K antagonists for thoracoscopic ablation in patients with persistent atrial fibrillation: a randomized controlled trial","volume":"35","author":"Y Lee","year":"2023","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1093\/europace\/eut406","article-title":"Incidence of cerebral thromboembolic events during long-term follow-up in patients treated with transcatheter ablation for atrial fibrillation","volume":"16","author":"F Gaita","year":"2014","journal-title":"Europace"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/eurheartj\/ehu421","article-title":"Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: long-term follow-up in nationwide cohort of Denmark","volume":"36","author":"D Karasoy","year":"2015","journal-title":"Eur Heart J"},{"issue":"12","key":"ref25","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1253\/circj.CJ-19-0602","article-title":"Current status and clinical outcomes of oral anticoagulant discontinuation after ablation for atrial fibrillation in Japan-findings from the AF Frontier Ablation Registry","volume":"83","author":"Y Okumura","year":"2019","journal-title":"Circ J"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/europace\/euz235","article-title":"The safety of discontinuation of oral anticoagulation therapy after apparently successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry study","volume":"22","author":"W Y Yang","year":"2020","journal-title":"Europace"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"e0253709","DOI":"10.1371\/journal.pone.0253709","article-title":"Discontinuation of oral anticoagulation therapy after successful atrial fibrillation ablation: a systematic review and meta-analysis of prospective studies","volume":"16","author":"X H Liu","year":"2021","journal-title":"PLoS One"},{"issue":"42","key":"ref29","doi-asserted-by":"crossref","first-page":"e35518","DOI":"10.1097\/MD.0000000000035518","article-title":"It can be safe to discontinue oral anticoagulants after successful atrial fibrillation ablation: a systematic review and meta-analysis of cohort studies","volume":"102","author":"X Wang","year":"2023","journal-title":"Medicine (Baltimore)"},{"issue":"07","key":"ref30","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1161\/CIRCULATIONAHA.119.039609","article-title":"Rivaroxaban with or without aspirin in patients with heart failure and chronic coronary or peripheral artery disease","volume":"140","author":"K R Branch","year":"2019","journal-title":"Circulation"},{"issue":"12","key":"ref31","doi-asserted-by":"crossref","first-page":"e32516","DOI":"10.1016\/j.heliyon.2024.e32516","article-title":"Real world risk of discontinuing oral anticoagulation after successful catheter ablation for atrial fibrillation","volume":"10","author":"Z T Fei","year":"2024","journal-title":"Heliyon"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"e251320","DOI":"10.1001\/jamanetworkopen.2025.1320","article-title":"Discontinuation of oral anticoagulation after successful atrial fibrillation ablation","volume":"8","author":"T Iwawaki","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"13","key":"ref33","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2408308","article-title":"Left atrial appendage closure after ablation for atrial fibrillation","volume":"392","author":"O M Wazni","year":"2025","journal-title":"N Engl J Med"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"123652","DOI":"10.1016\/j.wneu.2024.123652","article-title":"Prevalence and risk factors of stroke in patients with nonvalvular atrial fibrillation: a case-control study","volume":"195","author":"Y Song","year":"2025","journal-title":"World Neurosurg"},{"issue":"12","key":"ref35","doi-asserted-by":"crossref","first-page":"e016380","DOI":"10.1161\/JAHA.120.016380","article-title":"Association of atrial fibrillation without cardiovascular comorbidities and stroke risk: from the REGARDS study","volume":"9","author":"M J Singleton","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.jacc.2017.12.011","article-title":"Stroke risk in patients with reduced ejection fraction after myocardial infarction without atrial fibrillation","volume":"71","author":"J P Ferreira","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"38","key":"ref37","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"P Kirchhof","year":"2016","journal-title":"Eur Heart J"},{"issue":"12","key":"ref38","doi-asserted-by":"crossref","first-page":"857","DOI":"10.7326\/0003-4819-146-12-200706190-00007","article-title":"Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation","volume":"146","author":"R G Hart","year":"2007","journal-title":"Ann Intern Med"},{"issue":"10","key":"ref39","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1001\/jama.2015.10725","article-title":"Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation","volume":"314","author":"L Melgaard","year":"2015","journal-title":"JAMA"},{"issue":"05","key":"ref40","doi-asserted-by":"crossref","first-page":"e014574","DOI":"10.1161\/JAHA.119.014574","article-title":"Risks of bleeding and stroke based on CHA2DS2-VASc scores in Japanese patients with atrial fibrillation: a large-scale observational study using real-world data","volume":"9","author":"T Maeda","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"10","key":"ref41","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1016\/j.hrthm.2025.04.029","article-title":"Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: concomitant and sequential cohorts of the OPTION randomized controlled trial","volume":"22","author":"W Saliba","year":"2025","journal-title":"Heart Rhythm"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2906-7109.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T22:57:25Z","timestamp":1784156245000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2906-7109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":40,"URL":"https:\/\/doi.org\/10.1055\/a-2906-7109","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7,3]]},"published":{"date-parts":[[2026,7,3]]}}}