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2026 AF Symposium
ALONE-AF Trial—Discontinuation of Anticoagulant After Catheter Ablation for AF?
Dr. Boyoung-Joung, MD
Dr. Boyoung Joung of Yonsei University, Seoul, South Korea presented a study that may be one of the most important posts for patients at this year’s AF Symposium.
Anticoagulate For Life?
Dr. Joung stated that many patients who have had a successful ablation and have stroke risk factors have been prescribed direct oral anticoagulants (DOAC) for the rest of their lives, although there is no evidence from randomized trials to indicate that a lifetime on anticoagulants is necessary. The ALONE-AF randomized trial was designed to address this important long-term question for patients.
CHA2DS2-VASc risk grading system: Used to estimate the stroke risk of A-Fib patients. A score of ≥2 indicate increased stroke risk; a score 4 or above-≥4 indicates high-risk.
The ALONE-AF Trial
ALONE-AF (Anticoagulant One Year After Ablation of atrial fibrillation in patients with Atrial Fibrillation) studied 840 adult South Korean patients in year 2 following their catheter ablation who stayed A-Fib free. Among these patients, the risk of stroke using the CHA2DS2-VASc risk scale was intermediate-to-high risk. The CHA2DS2-VASc stroke risk average was 2.1.
Study Groups
Participants were randomized to either continue anticoagulation (DOAC group) or discontinue it (no-DOAC group).
Reduction In Bleeding
These patients were followed during the second year after their successful ablation. They were studied for occurrence of major bleeding, stroke, and systemic embolism (adverse events).
Adverse events occurred in 2.2% in the direct oral anticoagulant (DOAC) group vs. 0.3% in the no-DOAC group. This significant difference was mainly driven by a reduction in bleeding events.
Major bleeding did occur in 5 patients in the continue DOAC group (1.4%) but did not occur in the discontinue DOAC group.
Researchers found discontinuing anticoagulation therapy resulted in a lower risk of major bleeding.
Rate of Ischemic Stroke
The rate of ischemic stroke was 0.3% in the discontinue group vs 0.8% in the continue group (this difference didn’t reach clinical significance). The rate for systemic embolism also favored the discontinue group but was relatively low in both groups.
Even High-Risk Patients Can Stop Anticoagulants After Ablation
Dr. Joung stated that even among high-risk patients (CHA2DS2-VASc score 4 or above-≥4), discontinuing anticoagulation after the first year of a successful ablation was not associated with an increased stroke risk, major bleeding, or systemic embolism.
GFX source: JAMANetwork.com; Vol. 334, No. 14
Editor’s Comments
Editor’s CommentsMajor Health Breakthrough For Patients: This study by Dr. Joung was very well designed (even brilliant!). It points out that the need of prescribing continued anticoagulation after a successful catheter ablation may diminish after the first year.
Anticoagulation-For-Life is Risky: After being A-Fib free for a year, patients in the continued anticoagulation group had a significantly greater risk of major bleeding than those not taking blood thinners.
What This Means to Patients: Many patients do not want to be on oral anticoagulants after their successful catheter ablation, especially not for life.
Anticoagulation-for-life after a catheter ablation may not be appropriate and may even harm patients who are A-Fib free.
In fact, anticoagulants increase the risk of hemorrhagic-type strokes (bleeding in the brain). For more about this, see my article: Anticoagulants Increase Risk of Hemorrhagic-Type Strokes.
