#3-36E. Can Anticoagulation Be Stopped After Successful AF Ablation? The OCEAN Trial Results (N Engl J Med, 2026)

Current clinical guidelines recommend indefinite oral anticoagulation after atrial fibrillation (AF) ablation based on stroke risk scores, regardless of procedural success; however, the necessity of this approach remains debated. The OCEAN trial addressed this uncertainty by randomizing 1,284 patients with successful AF ablation at least one year prior and existing stroke risk factors to receive either rivaroxaban or aspirin. The study found no significant difference between the two groups regarding the primary composite outcome of stroke, systemic embolism, or new covert embolic stroke detected by MRI over three years. Crucially, the trial demonstrated exceptionally low event rates in both arms (0.31 vs. 0.66 events per 100 patient-years), suggesting that successful ablation may significantly lower stroke risk independently of pharmacotherapy. However, a critical limitation for appraisal is that these lower-than-anticipated event rates rendered the study underpowered to detect a statistically significant benefit of anticoagulation. For physicians, these findings offer provocative evidence that indefinite anticoagulation may not be mandatory for all patients with successful rhythm control, though the potential for bleeding risks with continued therapy must be carefully weighed against the lack of clear efficacy benefit found in this cohort.

Citation: Verma A, Birnie DH, Jiang C, et al. Antithrombotic Therapy after Successful Catheter Ablation for Atrial Fibrillation. N Engl J Med. 2026. DOI: 10.1056/NEJMoa2509688

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