Anticoagulation After AF Ablation
Integrates CHA₂DS₂-VASc, bleeding risk, time from ablation, rhythm surveillance, recurrence, and major thromboembolic modifiers.
Patient and ablation
Age
Sex
Months since ablation
The randomized discontinuation trials enrolled patients at least 1 year after ablation.
Rhythm surveillance
CHA₂DS₂-VASc
Heart failure or LVEF ≤40%
Hypertension
Diabetes mellitus
Prior stroke, TIA, or systemic embolism
Vascular disease
Prior MI, PAD, or aortic plaque.
Bleeding risk
SBP >160 mmHg
Abnormal renal function
Abnormal liver function
Major bleeding history or predisposition
Labile INR on warfarin
Antiplatelet therapy or chronic NSAID use
Alcohol excess
Post-ablation modifiers
Documented recurrent atrial arrhythmia
AF, atrial flutter, or atrial tachycardia.
Severe left atrial enlargement
Significant atrial myopathy or fibrosis
Other high-risk thromboembolic condition
Cannot tolerate long-term anticoagulation
Includes recurrent clinically important bleeding.