Anticoagulation after Ablation for Atrial Fibrillation

This Clinical Decisions article presents a case vignette of a 74-year-old man with persistent atrial fibrillation and hypertension, who recently experienced a fall and sustained a bleeding injury while on apixaban. With a CHA₂DS₂-VASc score of 2 (soon to be 3) and a HAS-BLED score of 2, the central question concerns whether anticoagulation should be continued following catheter ablation. Two expert viewpoints are discussed:

• One expert argues that anticoagulation should continue regardless of ablation outcome, citing risks of asymptomatic recurrence, guideline recommendations, and stroke risk stratification.
• The opposing view supports discontinuation if rigorous post-procedural monitoring confirms absence of atrial fibrillation, advocating for patient-centered shared decision making and citing emerging data and evolving device surveillance.

The article encourages clinicians to weigh stroke prevention against bleeding risk and technological reliability, and to respect patient values in the absence of definitive trial evidence

This Clinical Decisions article presents a case vignette of a 74-year-old man with persistent atrial fibrillation and hypertension, who recently experienced a fall and sustained a bleeding injury while on apixaban. With a CHA₂DS₂-VASc score of 2 (soon to be 3) and a HAS-BLED score of 2, the central question concerns whether anticoagulation should be continued following catheter ablation. Two expert viewpoints are discussed:

• One expert argues that anticoagulation should continue regardless of ablation outcome, citing risks of asymptomatic recurrence, guideline recommendations, and stroke risk stratification.
• The opposing view supports discontinuation if rigorous post-procedural monitoring confirms absence of atrial fibrillation, advocating for patient-centered shared decision making and citing emerging data and evolving device surveillance.

The article encourages clinicians to weigh stroke prevention against bleeding risk and technological reliability, and to respect patient values in the absence of definitive trial evidence