Aspirin vs. Anticoagulation After AF Ablation: No Difference, Says OCEAN Trial

The OCEAN trial, presented at the American Heart Association 2025 Scientific Sessions, found no significant difference in stroke, systemic embolism, or MRI-detected cerebral infarctions between aspirinand rivaroxaban (Xarelto) after successful atrial fibrillation (AF) ablation.

Over a 36-month follow-up, both groups showed remarkably low event rates, with primary outcomes occurring in 0.8% (rivaroxaban) vs 1.4% (aspirin)—a nonsignificant difference. Major bleeding was rare but slightly higher in the anticoagulation arm (1.6% vs 0.6%).

Experts noted that these results echo findings from the ALONE-AF trial, suggesting that in low-risk post-ablationpatients (CHA₂DS₂-VASc ≤3, no recent stroke), it may be reasonable to discontinue oral anticoagulation under close supervision.

While current AHA/ACC/HRS guidelines still recommend continued anticoagulation post-ablation, OCEAN provides important real-world evidence to inform shared decision-making between physicians and patients.

---

Key Takeaway:
For stable, low-to-moderate-risk AF patients one year post-ablation, aspirin and rivaroxaban appear equally effective in preventing stroke and embolic events—with very low absolute risk. Clinical judgment and individualized discussionremain essential before stopping oral anticoagulation.