Current Status and Clinical Outcomes of Oral Anticoagulant Discontinuation After Ablation for Atrial Fibrillation in Japan - Findings From the AF Frontier Ablation Registry

Circ J. 2019 Nov 25;83(12):2418-2427. doi: 10.1253/circj.CJ-19-0602. Epub 2019 Oct 16.


Background: The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHA2DS2-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHA2DS2-VASc scores but not with OAC status.

Conclusions: Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.

Keywords: Ablation; Anticoagulant drugs; Atrial fibrillation; Mortality; Stroke.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / therapy*
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / mortality
  • Drug Administration Schedule
  • Female
  • Hemorrhage / chemically induced
  • Humans
  • Incidence
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / mortality
  • Ischemic Attack, Transient / prevention & control*
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / prevention & control*
  • Time Factors
  • Treatment Outcome


  • Anticoagulants