Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation

Nakano, Tomoaki; Oka, Takafumi; Okayama, Keita; Tanaka, Nobuaki; Masuda, Masaharu; Watanabe, Tetsuya; Minamiguchi, Hitoshi; Egami, Yasuyuki; Miyoshi, Miwa; Okada, Masato; Matsuda, Yasuhiro; Kawasaki, Masato; Inoue, Koichi; Hikoso, Shungo; Sunaga, Akihiro; Dohi, Tomoharu; Okada, Katsuki; Nakatani, Daisaku; Sotomi, Yohei; Sakata, Yasushi

doi:https://doi.org/10.1016/j.jjcc.2025.04.004

Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation

Nakano, Tomoaki; Oka, Takafumi; Okayama, Keita et al.

Journal of Cardiology, 2025, 86(4), 359-365

アクセス数:218件（2026-05-02 03:57 集計）

固定URL: https://hdl.handle.net/11094/103887

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タイトル	Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation
著者	NRID 1000090723180 1000090723180 ORCID 0009-0008-4991-0087 0009-0008-4991-0087 researchmap permalink tomoaki85927 tomoaki85927 Scopus Author ID 57218381901 57218381901 著者名 Nakano, Tomoaki
	NRID 1000030647285 1000030647285 researchmap permalink Takafumioka0410 Takafumioka0410 Scopus Author ID 8712739400 8712739400 著者名 Oka, Takafumi
	NRID 1000050705168 1000050705168 researchmap permalink oky oky Scopus Author ID 35181800600 35181800600 著者名 Okayama, Keita
	著者名 Tanaka, Nobuaki
	著者名 Masuda, Masaharu
	NRID 1000060897825 1000060897825 著者名 Watanabe, Tetsuya
	NRID 1000090648495 1000090648495 著者名 Minamiguchi, Hitoshi
	著者名 Egami, Yasuyuki
	著者名 Miyoshi, Miwa
	著者名 Okada, Masato
	著者名 Matsuda, Yasuhiro
	著者名 Kawasaki, Masato
	著者名 Inoue, Koichi
	NRID 1000030423164 1000030423164 ORCID 0000-0003-2284-1970 0000-0003-2284-1970 researchmap permalink hikoso_osakauniv hikoso_osakauniv Scopus Author ID 57578643800 57578643800 著者名 Hikoso, Shungo
	NRID 1000010812258 1000010812258 ORCID 0000-0003-2590-6696 0000-0003-2590-6696 researchmap permalink 10812258 10812258 Scopus Author ID 56647970400 56647970400 著者名 Sunaga, Akihiro
	NRID 1000090838137 1000090838137 researchmap permalink dohi_1230 dohi_1230 Scopus Author ID 35071263000 35071263000 著者名 Dohi, Tomoharu
	NRID 1000020776489 1000020776489 ORCID 0000-0002-1725-781X 0000-0002-1725-781X researchmap permalink katsuki_okada katsuki_okada Scopus Author ID 13613369100 13613369100 著者名 Okada, Katsuki
	NRID 1000060444535 1000060444535 ORCID 0000-0002-1534-2033 0000-0002-1534-2033 researchmap permalink dsyma dsyma Scopus Author ID 6603545219 6603545219 著者名 Nakatani, Daisaku
	NRID 1000090885253 1000090885253 ORCID 0000-0002-7564-2978 0000-0002-7564-2978 researchmap permalink sotomiyohei sotomiyohei Scopus Author ID 57115149800 57115149800 著者名 Sotomi, Yohei
	NRID 1000000397671 1000000397671 ORCID 0000-0002-5618-4721 0000-0002-5618-4721 researchmap permalink C4589 C4589 Scopus Author ID 35395964700 35395964700 著者名 Sakata, Yasushi
キーワード等	Atrial fibrillation
	Catheter ablation
	Hemorrhage
	Risk assessment
	Thromboembolism
内容	Nakano T., Oka T., Okayama K., et al. Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation. Journal of Cardiology 86, 359 (2025); https://doi.org/10.1016/j.jjcc.2025.04.004.
抄録	Background Guidelines state that oral anticoagulants (OACs) should be continued after catheter ablation for atrial fibrillation (AF) based on thromboembolic risk stratification, regardless of procedural results. However, whether OACs could be discontinued in low-thromboembolic-risk patients remains unclear. Methods This was a retrospective follow-up study from the EARNEST-PVI (NCT03514693) trial, which compared the efficacy of pulmonary vein isolation (PVI)-alone and PVI-plus strategies for persistent AF ablation. A total of 427 patients with CHADS₂ score of ≤2 points were divided into two groups: OAC continuation throughout the overall period (group C, n = 205) and OAC discontinuation within 1 year after ablation (group D, n = 222). The incidence of thromboembolic and bleeding events was analyzed. Results AF recurrence (33 % vs. 17 %, p < 0.001), thromboembolic events (1.39 % vs. 0 % per year, p = 0.005), and overall bleeding event rates (7.54 % vs. 3.32 % per year, p = 0.003) were higher in group C than in group D. There was no significant difference in major bleeding event rates between the C and D groups (0.51 % vs. 0.67 % per year, p = 0.686). However, a higher number of overall bleeding events, including major and clinically relevant non-major events, was observed in group C (adjusted hazards ratio: 2.04, 95 % confidence interval: 1.14–3.65, p = 0.016). Conclusions Thromboembolic events and overall bleeding events were fewer in the OAC discontinuation group compared with the OAC continuation group. Discontinuation of OACs might be considered in patients with low CHADS₂ score after catheter ablation of persistent AF.
出版者	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
収録物名	Journal of Cardiology
巻(号)	86(4)
ページ	359-365
刊行年月	2025-10-17
言語	英語
ハンドルURL	https://hdl.handle.net/11094/103887
PISSN	09145087
eISSN	18764738
関連情報 (isIdenticalTo)	DOI (出版社版) https://doi.org/10.1016/j.jjcc.2025.04.004
アクセス権	open access
権利情報	This article is licensed under a Creative Commons Attribution 4.0 International License.
出版タイプ	Version of Record
カテゴリ	学術雑誌論文 Journal Article

資源タイプ	学術雑誌論文
ローカル資源タイプ	学術雑誌論文
DCMI資源タイプ	text
DCTERMS.bibliographicCitation	Journal of Cardiology. 2025, 86(4), p. 359-365
DC.title	Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation
DC.creator	Nakano, Tomoaki
	Oka, Takafumi
	Okayama, Keita
	Tanaka, Nobuaki
	Masuda, Masaharu
	Watanabe, Tetsuya
	Minamiguchi, Hitoshi
	Egami, Yasuyuki
	Miyoshi, Miwa
	Okada, Masato
	Matsuda, Yasuhiro
	Kawasaki, Masato
	Inoue, Koichi
	Hikoso, Shungo
	Sunaga, Akihiro
	Dohi, Tomoharu
	Okada, Katsuki
	Nakatani, Daisaku
	Sotomi, Yohei
	Sakata, Yasushi
DC.publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
DC.language' scheme='DCTERMS.RFC1766	英語
DC.type' scheme='DCTERMS.DCMIType	text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2025-10-17
DC.identifier	https://doi.org/10.1016/j.jjcc.2025.04.004
DC.subject	Atrial fibrillation
	Catheter ablation
	Hemorrhage
	Risk assessment
	Thromboembolism
DC.description	Nakano T., Oka T., Okayama K., et al. Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation. Journal of Cardiology 86, 359 (2025); https://doi.org/10.1016/j.jjcc.2025.04.004.
DCTERMS.abstract	Background Guidelines state that oral anticoagulants (OACs) should be continued after catheter ablation for atrial fibrillation (AF) based on thromboembolic risk stratification, regardless of procedural results. However, whether OACs could be discontinued in low-thromboembolic-risk patients remains unclear. Methods This was a retrospective follow-up study from the EARNEST-PVI (NCT03514693) trial, which compared the efficacy of pulmonary vein isolation (PVI)-alone and PVI-plus strategies for persistent AF ablation. A total of 427 patients with CHADS₂ score of ≤2 points were divided into two groups: OAC continuation throughout the overall period (group C, n = 205) and OAC discontinuation within 1 year after ablation (group D, n = 222). The incidence of thromboembolic and bleeding events was analyzed. Results AF recurrence (33 % vs. 17 %, p < 0.001), thromboembolic events (1.39 % vs. 0 % per year, p = 0.005), and overall bleeding event rates (7.54 % vs. 3.32 % per year, p = 0.003) were higher in group C than in group D. There was no significant difference in major bleeding event rates between the C and D groups (0.51 % vs. 0.67 % per year, p = 0.686). However, a higher number of overall bleeding events, including major and clinically relevant non-major events, was observed in group C (adjusted hazards ratio: 2.04, 95 % confidence interval: 1.14–3.65, p = 0.016). Conclusions Thromboembolic events and overall bleeding events were fewer in the OAC discontinuation group compared with the OAC continuation group. Discontinuation of OACs might be considered in patients with low CHADS₂ score after catheter ablation of persistent AF.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	103887
citation_title	Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation
citation_author	Nakano, Tomoaki
	Oka, Takafumi
	Okayama, Keita
	Tanaka, Nobuaki
	Masuda, Masaharu
	Watanabe, Tetsuya
	Minamiguchi, Hitoshi
	Egami, Yasuyuki
	Miyoshi, Miwa
	Okada, Masato
	Matsuda, Yasuhiro
	Kawasaki, Masato
	Inoue, Koichi
	Hikoso, Shungo
	Sunaga, Akihiro
	Dohi, Tomoharu
	Okada, Katsuki
	Nakatani, Daisaku
	Sotomi, Yohei
	Sakata, Yasushi
citation_publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
citation_language	英語
citation_date	2025-10-17
citation_journal_title	Journal of Cardiology
citation_volume	86
citation_issue	4
citation_firstpage	359
citation_lastpage	365
citation_doi	https://doi.org/10.1016/j.jjcc.2025.04.004
citation_public_url	https://hdl.handle.net/11094/103887

Association between oral anticoagulants continuation on thromboembolism and bleeding events in patients with CHADS₂ score 0–2 points after catheter ablation for persistent atrial fibrillation

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