Perspective:

The majority of ablation-related complications are related to either bleeding or clotting problems, and the electrophysiologists walk a tightrope between strokes and pericardial effusions and other vascular injury. The present study does not address the intraprocedural anticoagulation issues, but rather looks at the value of oral anticoagulation post-ablation procedure in patients who have no other indication for oral anticoagulants. There has been very little guidance in this respect. Most physicians use antiplatelet agents for “less extensive” ablation and oral anticoagulant therapy after “extensive” ablation. A prior study suggested that aspirin 81 mg daily may be insufficient to prevent embolic events.

In the present study, patients who did not have pre-procedure indication for anticoagulation and who did not have high-risk features were prescribed full-dose aspirin for 4-6 weeks or were continued on the previous nonaspirin antiplatelet agent. All other patients were put on heparin starting 4-8 hours post-procedure and resumed anticoagulation or had uninterrupted anticoagulation. The authors report that despite only 6% of patients receiving a new regimen with a DOAC or warfarin after ablation, the risk of embolic events was low, with the incidence of stroke being 0.3%, TIA 0.15%, and pulmonary embolism 0.3%, suggesting that many patients can do without oral anticoagulants.