JAMA

ESC 2025: Stopping anticoagulation after afib ablation may reduce bleeding without raising stroke risk

September 3, 2025

Lifelong direct oral anticoagulation (DOAC) may be unnecessary for patients maintaining stable rhythm ≥1 year post-ablation, according to findings presented at ESC Congress 2025, potentially reshaping management for select low-event-risk individuals.

Study details: ALONE-AF (NCT04432220) was an open-label, randomized superiority study conducted at 18 sites in South Korea enrolling 840 patients with non-valvular afib who'd undergone successful catheter ablation and remained arrhythmia-free for ≥12 months. All had ≥1 stroke risk factor determined using the CHA₂DS₂-VASc score (range, 0-9) and no documented recurrence of atrial arrhythmia for ≥1 year after catheter ablation for afib. Participants were randomized to continue DOAC or discontinue therapy.

Results: At 24 months, patients who discontinued DOAC had a significantly lower rate of net adverse clinical events (stroke, systemic embolism, or major bleeding) compared with those who continued therapy (0.3% vs. 2.2%; confidence interval [CI], -3.5 to -0.3; p=0.024). Major bleeding occurred in 1.4% of the DOAC group and 0% of the no-DOAC group (absolute difference, -1.4 percentage points; 95% CI, -2.6 to -0.2). Rates of ischemic stroke and systemic embolism were low and not significantly different between groups.

Sources:

Kim D, et al; ALONE-AF Investigators. (2025, August 31). JAMA. Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40886309/

(2025, August 31). European Society of Cardiology. New data on oral anticoagulation after successful ablation of atrial fibrillation. [Press release]. https://www.escardio.org/The-ESC/Press-Office/Press-releases/New-data-on-oral-anticoagulation-after-successful-ablation-of-atrial-fibrillation