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

Number of Access:111（2026-04-05 10:12 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/103887

Link to primary information

File	Format	Terms of use	Size	Views	Date.Available	Description	information
JCardiol_86_4_359	pdf	None	853 KB	21	2026.02.26

Creative Commons : Attribution

Item Information

Output File Export EndNote Basic Export Mendeley

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
Creator	NRID 1000090723180 1000090723180 ORCID 0009-0008-4991-0087 0009-0008-4991-0087 researchmap permalink tomoaki85927 tomoaki85927 Scopus Author ID 57218381901 57218381901 CreatorName Nakano, Tomoaki
	NRID 1000030647285 1000030647285 researchmap permalink Takafumioka0410 Takafumioka0410 Scopus Author ID 8712739400 8712739400 CreatorName Oka, Takafumi
	NRID 1000050705168 1000050705168 researchmap permalink oky oky Scopus Author ID 35181800600 35181800600 CreatorName Okayama, Keita
	CreatorName Tanaka, Nobuaki
	CreatorName Masuda, Masaharu
	NRID 1000060897825 1000060897825 CreatorName Watanabe, Tetsuya
	NRID 1000090648495 1000090648495 CreatorName Minamiguchi, Hitoshi
	CreatorName Egami, Yasuyuki
	CreatorName Miyoshi, Miwa
	CreatorName Okada, Masato
	CreatorName Matsuda, Yasuhiro
	CreatorName Kawasaki, Masato
	CreatorName 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 CreatorName Hikoso, Shungo
	NRID 1000010812258 1000010812258 ORCID 0000-0003-2590-6696 0000-0003-2590-6696 researchmap permalink 10812258 10812258 Scopus Author ID 56647970400 56647970400 CreatorName Sunaga, Akihiro
	NRID 1000090838137 1000090838137 researchmap permalink dohi_1230 dohi_1230 Scopus Author ID 35071263000 35071263000 CreatorName 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 CreatorName Okada, Katsuki
	NRID 1000060444535 1000060444535 ORCID 0000-0002-1534-2033 0000-0002-1534-2033 researchmap permalink dsyma dsyma Scopus Author ID 6603545219 6603545219 CreatorName Nakatani, Daisaku
	NRID 1000090885253 1000090885253 ORCID 0000-0002-7564-2978 0000-0002-7564-2978 researchmap permalink sotomiyohei sotomiyohei Scopus Author ID 57115149800 57115149800 CreatorName Sotomi, Yohei
	NRID 1000000397671 1000000397671 ORCID 0000-0002-5618-4721 0000-0002-5618-4721 researchmap permalink C4589 C4589 Scopus Author ID 35395964700 35395964700 CreatorName Sakata, Yasushi
Subject	Atrial fibrillation
	Catheter ablation
	Hemorrhage
	Risk assessment
	Thromboembolism
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.
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.
Publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Source Title	Journal of Cardiology
Volume (Issue)	86(4)
Page	359-365
Date of Issued	2025-10-17
Language	English
Handle URL	https://hdl.handle.net/11094/103887
PISSN	09145087
eISSN	18764738
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1016/j.jjcc.2025.04.004
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCMI Type	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	English
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	English
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

Link to primary information

Item Information

Show details