NYU Langone Health Med-Lit Review
Clinical Question: Does continued oral anticoagulation after successful catheter ablation for atrial fibrillation (AF) reduce thromboembolic events compared with aspirin?
Background: Hospitalists commonly prescribe anticoagulation in patients admitted after catheter ablation for AF. Current guideline recommendations suggest anticoagulation according to the CHA₂DS₂-VASc score regardless of procedural success, although evidence to support this approach is limited and primarily observational.
Study Design: Randomized, blinded-outcome, open-label trial
Setting: Multicenter, international (56 centers across North America, Europe, and Asia)
Synopsis: The OCEAN trial randomly enrolled 1,284 adults with nonvalvular AF who were at least one year status post catheter ablation and had low to moderate stroke risk (mean CHA₂DS₂-VASc score, 2.2±1.1; 31.9% of patients with a score of at least 3). Participants were assigned to rivaroxaban 15 mg daily or aspirin 70 to 120 mg daily and followed for three years. The primary composite outcome (stroke, systemic embolism, or covert embolic stroke on brain MRI) was rare and not significantly different between groups (annualized event rates 0.31 versus 0.66 per 100 patient-years for rivaroxaban and aspirin, respectively). Major or fatal bleeding was uncommon (1.6% with rivaroxaban and 0.6% with aspirin), but clinically relevant nonmajor bleeding was higher with rivaroxaban. Limitations included low event rates overall, exclusion of high-risk subgroups, and use of a reduced rivaroxaban dose. These data suggest that in carefully selected patients with documented ablation success, the absolute risk of thromboembolism may be lower than predicted by risk scores alone.
Bottom Line: In patients with successful AF ablation and low-to-moderate stroke risk, continued anticoagulation increased bleeding and did not significantly reduce thromboembolic events, supporting careful individualized decisions regarding post-ablation anticoagulation.
Citation: Verma A, et al. Antithrombotic therapy after successful catheter ablation for atrial fibrillation. N Engl J Med. 2026;394(4):323-332. doi: 10.1056/NEJMoa2509688.
Video: View Dr. Saini’s video review.
Dr. Saini is a clinical assistant professor in the department of hospital medicine at NYU Langone–Long Island in Mineola, N.Y.
Excellent !