Wann kann die orale Antikoagulation abgesetzt werden?

Abstract

Prevention of stroke is one of the most important therapy goals in the treatment of atrial fibrillation. Oral anticoagulation agents however, may result in bleeding complications. It would be desirable to stop oral anticoagulation (OAC) after successful ablation of atrial fibrillation e. g. after catheter ablation. The data basis for the decision to discontinue OAC is very weak. In patients with prior cerebral infarction, OAC should be continued indefinitely. In patients with a relatively low CHA₂DS₂VASc score (≤ 2) a discontinuation of OAC may be considered after 1 year after successful catheter ablation and thorough follow-up. Ideally, patients have a continuous monitoring device e.g. reveal or pacemaker implanted to assure complete freedom from recurrent arrhythmias. In patients after electrical cardioversion, OAC should be performed for four weeks even if the CHA₂DS₂VASc score is zero. In summary, discontinuation of OAC should be very carefully considered. Patients prio to ablation should be advised that ablation therapy does not aim for OAC discontinuation but for control of symptoms.

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