Successful post ablation anticoagulants? Maybe Not

The article is not behind a paywall. Here is the visual abstract.

Those results are very slim. Very. At most is suggests that those whose AF is well controlled, and who have no other comorbidity risks of stroke due to thromboembolitic events. can safely discontinue DOACs. But we already knew that. Many EPs will advise a patient to remain on a DOAC just for insurance, especially if other risk factors are at play....age for example. Even so, many EPs will agree that an otherwise healthy patient can probably safely discontinue taking a DOAC (which, if nothing else, will save some serious coin). Again, IF nothing else about their recent history makes discontinuing a DOAC risky, then an AF patient in 'remission' via successful ablation can stop a DOAC, and he should expect not to have a stroke related to the AF.
In fact, these results would suggest to me that, given their cohorts had an average CHA2DS2-VASc score of 2.1, above the limit at which a DOAC is normally prescribed, the CHA2DS2-VASc parameter might stand some rethinking....upward. A bit. Maybe to 3? More study needed.

These 2 videos by Dr Sanjay Gupta of York Cardiology, UK relate to your question about DOACs. I find his videos to be informative and pragmatic, and his speaking voice calm and reassuring.

I saw and read that article and yes interesting reading. But as always there is a "but" after cardiologists drilling into people the potential for clots for years I wonder how many will follow the advice. Also can't help but think that somewhere way,way back in the physician's mind is that term "malpractice" where some patients find a lawyer who convinces them that suggesting that they go of DOAC was the reason for that future clot. It's not a simple world out there.

I think no matter what a doctor recommends, there is a risk that things may not go as planned. Does that constitute malpractice? I'm not so sure.

Balancing the risk of two bad outcomes, brain damage from a bleed or clot, is the challenge. This paper provides evidence that in a selected group of patients, namely those afib free at 1 yr post ablation, had better outcomes off anticoagulants. I think a lot of conservative cardiologists will be taking patients off anticoagulants based on this paper. A head bleed can be more devastating than a stroke. In patients who are active and willing to do monitoring, discontinuation of anticoagulants is a really good thing. Apixaban ain’t cheap!

Neither do I but in today's world the temperature of a cup of coffee is grounds for a lawsuit.

Your correct in stating that there is a very select group for which this applies. But as with so many other things the more spent on researching a specific thing the result seems to be a changing perspective. Men who follow PSA guidelines have seen those change over the years, leaving many with questions. Even dairy fats have become a new gray area. Always a changing environment.