New Evidence Suggests DOACs May Be Stopped After Successful AF Ablation in Low-Risk Patients
A new analysis from the OCEAN trial presents a provocative finding for clinicians and patients managing atrial fibrillation (AF): for low-risk individuals who have undergone successful AF ablation, continuing oral anticoagulants (DOACs) may not offer a clear advantage in preventing stroke or other adverse events compared with stopping them and using aspirin instead.
AF, a common heart rhythm disorder, increases stroke risk due to potential blood clots forming in the atria. After a successful ablation procedure, which aims to restore and maintain a normal rhythm, questions arise about the ongoing need for anticoagulation. Historically, many guidelines recommended continuing DOACs for a period after ablation, with some suggesting indefinite therapy for certain patients. The OCEAN trial’s recent findings challenge this practice in a specific, low-risk cohort.
What the OCEAN Trial Found
The trial compared continuing DOAC therapy against stopping DOACs and using aspirin in patients who had a successful AF ablation and were classified as low risk for stroke. The primary outcome was a composite of stroke, systemic embolism, and major bleeding. Results showed no statistically significant difference between the groups in these adverse outcomes. In other words, among low-risk patients, stopping DOACs after a successful ablation did not lead to a higher incidence of stroke or other major events compared with ongoing DOAC use or with aspirin as a secondary preventive strategy.
The implications are meaningful: for carefully selected patients, the net clinical benefit may tilt toward stopping routine DOAC therapy after ablation, reducing medication burden and the risk of DOAC-related bleeding, without compromising safety. Of course, this interpretation hinges on accurate risk stratification and robust shared decision-making between patients and clinicians.
Who Might Be Suitable for Stopping DOACs?
Low-risk patients are the key focus of these findings. Typical criteria include a short duration of AF before ablation, successful rhythm control post-procedure, absence of additional risk factors like prior stroke, diabetes, or significant structural heart disease, and a favorable bleeding risk profile. It is essential to assess individual patient factors—age, comorbid conditions, and personal preferences—before altering anticoagulation plans. The decision should be revisited if new risk factors emerge or if there are recurrent episodes of atrial fibrillation after ablation.
Clinical Considerations and Next Steps
Clinicians considering a strategy to discontinue DOACs after successful ablation should ensure rigorous follow-up. This includes regular rhythm monitoring to detect recurrences, reassessment of stroke risk, and a clear plan for resuming anticoagulation if AF recurs or if the patient’s risk profile changes. Patients should be counseled on recognizing symptoms of stroke or bleeding and instructed on when to seek urgent care.
These findings do not suggest that stopping DOACs is appropriate for all AF patients. High-risk individuals—such as those with a history of stroke, persistent AF, or significant comorbidities—may still require ongoing anticoagulation. The OCEAN trial adds a critical data point to the ongoing debate about personalizing AF management, highlighting the potential to reduce medication burden without compromising safety in well-selected patients.
Bottom Line
The OCEAN trial advances our understanding of AF after ablation by suggesting that, for a carefully defined, low-risk group, stopping DOAC therapy could be feasible without increasing the risk of stroke or major adverse events. As always, personalized risk assessment and close follow-up are essential to ensure patient safety and optimal outcomes.
