Discontinuation of oral anticoagulants is common after catheter ablation in older patients with atrial fibrillation.

Aims: Guidelines recommend continuing oral anticoagulation (OAC) after atrial fibrillation (AF) ablation based on stroke risk, yet real-world post-procedural OAC management remains poorly characterized. We aimed to evaluate contemporary patterns of OAC use after AF ablation and identify predictors of OAC discontinuation. Methods and results: Using Medicare claims from 2013-2022, we established a cohort of patients undergoing a first AF ablation and assessed patterns of OAC discontinuation during the subsequent year. We defined OAC discontinuation as a dispensing gap ≥60 days. Baseline characteristics were evaluated as predictors of discontinuation using least absolute shrinkage and selection operator Cox regression. Among 208 232 AF patients (mean age 74.5, 47% women) undergoing ablation, 58% were taking OAC following ablation, 24% discontinued between 3 and 12 months, 8% discontinued within 3 months, and 10% did not use OAC within 3 months. Apixaban was the most commonly used OAC agent, while the use of warfarin declined over time. The overall rate of repeated ablation was 26%. We found that 44% of patients with CHA Conclusion: OAC discontinuation after AF ablation is common, including among patients at elevated stroke risk despite guideline recommendations for continued therapy. More data are needed on the clinical consequences of post-ablation OAC discontinuation.