N Engl J Med

After afib ablation, anticoagulants may not be needed

November 18, 2025

In the OCEAN trial, 1,284 patients with prior successful afib ablation and moderate stroke risk were randomized to rivaroxaban or aspirin for three years. Stroke and systemic embolism rates were very low in both groups (0.31 vs. 0.66 events per 100 patient-years), while major bleeding was higher with rivaroxaban (1.6% vs. 0.6%). Investigators conclude that continued anticoagulation offers no clear benefit over aspirin and increases bleeding risk, suggesting that many patients may safely discontinue oral anticoagulants after successful ablation.

Clinical takeaway: For patients with successful afib ablation and moderate stroke risk, transitioning from anticoagulation to antiplatelet therapy may be reasonable, pending guideline updates.

Source:

Verma A, et al; OCEAN Investigators. (2025, November 8). N Engl J Med. Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation. https://pubmed.ncbi.nlm.nih.gov/41211931/