Background and Aims Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS2 score. Methods This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS2 score. Results Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS2 scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS2 score group than that in the low CHADS2 score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS2 score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74–1.01, P = .06] for thromboembolism and was 1.51 (95% CI: 1.27–1.80, P < .001) for major bleeding. In the CHADS2 score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46–0.82, P = .001) for thromboembolism and was 1.05 (95% CI: 0.71–1.56, P = 0.81) for major bleeding. Conclusions This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient’s CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk.

中文翻译：

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房颤导管消融术后口服抗凝药：益处和风险

背景和目的 最近很少有大规模研究评估心房颤动 (AF) 导管消融 (CA) 后继续口服抗凝 (OAC) 治疗的风险和益处。本研究根据 CHADS2 评分评估了继续 OAC 治疗的状态以及继续 OAC 治疗与血栓栓塞和出血事件之间的关联。方法 这项回顾性研究纳入了日本全国管理索赔数据库中 2014 年 4 月至 2021 年 3 月期间因房颤接受 CA 的患者的数据。根据治疗方式的管理数据评估没有房颤复发的患者根据是否继续 OAC 治疗分为两组指数 CA 后 6 个月。主要结局是标志性的 6 个月后的血栓栓塞和大出血。经过治疗权重分析的逆概率后，根据 CHADS2 评分确定 OAC 延续与结果之间的关联。结果 在纳入的 231 374 名患者中，CHADS2 评分≤1、2 和≥3 的比例分别为 69.7%、21.6% 和 8.7%。其中，71% 的人在 6 个月时继续进行 OAC 治疗。高CHADS2评分组的OAC持续率高于低CHADS2评分组。在所有患者中，2451 名患者（每 100 人年 0.55 名）患有血栓栓塞，2367 名患者（每 100 人年 0.53 名）患有大出血。在 CHADS2 评分≤1 组中，继续 OAC 组血栓栓塞的风险比为 0.86 [95% 置信区间 (CI)：0.74–1.01，P = 0.06]，为 1.51（95% CI：1.27–1.80， P < .001) 表示大出血。在 CHADS2 评分≥3 组中，继续 OAC 组血栓栓塞的风险比为 0.61（95% CI：0.46-0.82，P = 0.001），为 1.05（95% CI：0.71-1.56，P = 0.81）用于大出血。结论 这项观察性研究表明，房颤 CA 后继续 OAC 治疗的益处和风险因患者的 CHADS2 评分而异。对于血栓栓塞风险较低的患者，继续 OAC 导致大出血的风险似乎超过了血栓栓塞风险的降低。