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2026 AF Symposium
Anticoagulants & Low-Risk Patients 3-Years Post-Ablation-OCEAN Trial
A recurring theme at this year’s AF Symposium was anticoagulation after a successful catheter ablation for Atrial Fibrillation—a very important subject to us A-Fib patients. The OCEAN trial is an insightful 3-year study on this topic.
Dr. Atul Verma, MD
Dr. Atul Verma (McGill Un. Health Center, Montreal, Canada) in his talk, “Discontinuation of Anticoagulation After Catheter Ablation for AF,” discussed the OCEAN trial. (OCEAN is short for Optimal Anticoagulation for Enhanced Risk Patients Post-Catheter Ablation for Atrial Fibrillation.)
Blood Thinners Forever?
In the past, if you had a catheter ablation, you’ve been told that you now must be on anticoagulants for life. But the OCEAN study shows that discontinuing blood thinners is acceptable and feasible for relatively low-risk patients.
The OCEAN Trial
At 56 different centers worldwide, 1,284 patients were enrolled. All patients had received catheter ablations and had remained A-Fib free for at least 1 year. Overall CHA2DS2-VASc stroke risk scores were low-to-intermediate for all patients.
Magnetic resonance imaging (MRI) is a non-invasive, radiation-free 3-D imaging technique used with A-Fib patients to assess post-ablation success, and evaluate stroke risk.
When the trial began, Magnetic Resonance Imaging (MRI) was used as to create a benchmark and again at follow-up 3 years later.
During the 3 year trial, one group received rivaroxaban (Xarelto) 15 mg daily. The second group received aspirin 75-120 mg. [Aspirin was used as it has negligible anti-stroke effects and is basically like taking a placebo.]
A key design feature of the OCEAN trial is that it used Magnetic Resonance Imaging (MRI) to detect silent ischemic events as well as strokes.
Follow-up MRI After 3 Years
OCEAN Trial: Optimal Anticoagulation for Enhanced Risk Patients Post-Catheter Ablation for Atrial Fibrillation. Source: NEJM.org
At the 3-year follow-up, trial patients were studied using MRI for occurrence of major bleeding, stroke, and systemic embolism or new cerebral blockage (infarct).
Adverse events occurred in 0.8% of the rivaroxaban group vs. 1.4% with the aspirin group. This was a low rate overall with no statistically significant difference between the groups. [These results were unexpectedly low, probably because both groups had a low stroke risk to begin with.]
Major or fatal bleeding was more common with rivaroxaban 1.6% versus 0.6% with aspirin, but this difference wasn’t statistically significant.
However, clinically relevant non-major bleeding occurred in 5.5% of the rivaroxaban group versus 1.6% of the aspirin group which was significant.
OCEAN Trial Conclusions
The researchers concluded that in low-to-intermediate-risk patients, stopping long-term oral anticoagulation (OAC) after a successful catheter ablation is acceptable and feasible.
Editor’s Comments
Editor’s CommentsWhy Aspirin? You’re probably wondering why one arm of the OCEAN study used aspirin which in general is no longer used alone as an effective anticoagulant to prevent stroke. The researchers could have used a placebo. But since aspirin does have limited anticoagulant effects, it makes for a better, more relevant contrast with Rivaroxaban.
After a Successful Ablation, Is Long-Term Anticoagulation Necessary? Many of us do not want to be on oral anticoagulants for life after we have gone through all the trouble of getting a successful catheter ablation. The OCEAN study and ALONE-AF suggest that, after you have a successful catheter ablation, you have a reduced risk of having a stroke and may not need to continue anticoagulation.
Beware of Anticoagulants-For-Life: Anticoagulants are not like taking vitamins. They do work and prevent strokes, but they are not benign. If you have a low risk of stroke and are in normal sinus rhythm after your ablation, the bleeding hazards of taking long-term oral anticoagulation (OAC) may outweigh its potential benefits. For more, see my article: Anticoagulants Increase Risk of Hemorrhagic-Type Strokes. (https://a-fib.com/anticoagulants-increase-risk-of-hemorrhagic-type-strokes-as-well/)
OCEAN and ALONE-AF Trials: The OCEAN and ALONE-AF trials were well designed and long-term, both were statistically strong, and both came to basically the same conclusion—it’s possible to stop anticoagulation after successful ablation in many patients.
What This Means for Patients: No more anticoagulation for life! OCEAN and ALONE-AF represent a major medical breakthrough for patients. For many of us, we no longer must be on anticoagulation for life!
