Abstract Body (Do not enter title and authors here): Introduction: While current guidelines recommend Oral anti-coagulant (OAC) use for ≥2 months post-atrial fibrillation (AF) ablation, with long-term therapy based on stroke risk rather than rhythm status, the safety of OAC discontinuation remains controversial. This meta-analysis evaluates OAC discontinuation (OFF OAC) versus continuation (ON OAC) post-ablation.
Methods: We systematically searched PubMed, Cochrane, Embase, Scopus, and clinicaltrial.gov through April 2025, identifying 28 relevant studies. Primary outcomes were thromboembolic events (TE) and major bleeding events (MBEs); secondary outcomes included all-cause mortality, AF recurrence, stroke, hemorrhage, and major adverse cardiovascular events (MACE). The analysis was conducted on R Studio v4.4.5. The Mantel-Haenszel model was used to pool the studies, and between-study variance was assessed through Der-Simonian Laird using I² statistics. Pooled estimates were reported as risk ratios (RR) with 95% confidence intervals (CIs).
Results: Pooled TEs across 17 studies showed no significant difference between the OFF OAC and ON OAC groups [RR 0.84 (95%CI: 0.68-1.04); I² = 14.1%]. However, MBEs were significantly lower in the OFF OAC group compared to the ON OAC group [RR 0.33 (95%CI: 0.21-0.51); I² = 91.3%]. Similarly, the OFF OAC group demonstrated a lower risk of hemorrhage [RR 0.22 (95%CI: 0.07-0.70); I² = 38.5%]. In contrast, the ON OAC group had higher all-cause mortality [RR 0.70 (95%CI: 0.49-1.01); I² = 51.2%] and AF recurrence [RR 0.51 (95%CI: 0.33-0.78); I² = 92.1%], though the mortality result trended toward significance. Notably, the OFF OAC group had a lower but statistically significant increase in stroke risk [RR 0.58 (95%CI: 0.41-0.82); I² = 52.1%] and MACE [RR 0.60 (95%CI: 0.37-0.98); I² = 64.7%] compared to the ON OAC group.
Conclusion: OAC discontinuation post-ablation reduces bleeding with similar stroke risk, requiring careful patient selection based on individual thromboembolic risk factors.