A 75-Year-Old Man with Symptomatic Paroxysmal Atrial Fibrillation and Hypertension

A 75-year-old man presented with symptomatic paroxysmal atrial fibrillation and hypertension. He did well on sotalol 120 mg twice daily and warfarin for six months, but then complained of frequent paroxysms which left him drained. He subsequently underwent catheter ablation of his fibrillation. He returned to your office 12 months later feeling quite well, with a well-controlled INR and reported no paroxysms. The EKG performed in the office confirmed sinus rhythm. The patient and his wife ask about discontinuing warfarin, since he has been "cured." To be cautious, you order a three-week Holter monitor, which shows no evidence of atrial fibrillation.

What would be your decision regarding anticoagulation for this patient?

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