Dual antiplatelet therapy is safe and efficient after left atrial appendage closure

Despite results of the PROTECT AF trial, many patients undergoing left atrial appendage closure (LAAC) have unconditional contraindications to warfarin.

We sought to investigate whether double antiplatelet therapy (DAPT) is safe in patients after LAAC.

Forty-four consecutive patients (22 males, mean age 74 ± 7.8 years) with non-valvular atrial fibrillation (NVAF) underwent LAAC procedure using a Watchman device followed by DAPT (75 mg/d aspirin and 75 mg/d clopidogrel). After the procedure and during 98 days' follow-up including transoesophageal echocardiography, peri-procedural complications and clinical outcomes were investigated.

Mean CHA2DS2-VASc score was 4.9 ± 1.5 and mean HAS-BLED score was 3.6 ± 0.8. The main LAAC indication was contraindication to anticoagulation reflected by HAS-BLED score ≥ 3 observed in 95.5% cases (among them history of bleeding in 38 patients, 90.5%). 36.4% of patients have history of stroke or transient ischaemic attack. The procedure was successful in 97.7%. Peri-procedural complications were tamponade (2.3%) and one death (2.3%) unrelated to the procedure with no bleeding or vascular complications. During follow-up neither stroke nor bleeding were observed, whereas two device related thrombi and two unrelated deaths occurred.

LAAC followed by DAPT seems to be a safe and efficient alternative for stroke prevention in patients with NVAF who have contraindications to anticoagulation therapy. This strategy may provide a significant reduction of events such as stroke and bleeding versus the score-predicted rate.