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Updated: Feb 12, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Dual antiplatelet therapy after percutaneous left atrial appendage occlusion: single center experience with the
Philippe B Bertrand1,2, Melanie Habran2, Karlijn Kenis2
1a Heart Center Hasselt, Jessa Ziekenhuis , Hasselt , Belgium.
Insights
Dual antiplatelet therapy (DAPT) after left atrial appendage occlusion (LAAO) in high-risk patients showed no strokes but led to major bleeding events. Optimal DAPT duration is needed to balance thrombosis prevention and bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Management
Background:
- Percutaneous left atrial appendage occlusion (LAAO) offers an alternative to anticoagulation for atrial fibrillation patients with high bleeding risk.
- Dual antiplatelet therapy (DAPT) is typically recommended post-LAAO to mitigate thrombotic risks.
- This study evaluates the safety and efficacy of DAPT in a high bleeding risk population undergoing LAAO.
Purpose of the Study:
- To assess the safety and efficacy of dual antiplatelet therapy (DAPT) following percutaneous left atrial appendage occlusion (LAAO).
- To evaluate clinical outcomes, including bleeding and thrombotic events, in high bleeding risk patients treated with DAPT post-LAAO.
- To inform optimal antithrombotic strategies after LAAO in this specific patient cohort.
Main Methods:
- A single-centre retrospective analysis of patients receiving DAPT after LAAO with the Amplatzer Cardiac Plug.
- Prospective follow-up of patient characteristics, procedural success, and clinical events (bleeding, stroke, adverse events).
- Assessment of changes in antithrombotic and anticoagulant regimens post-procedure.
Main Results:
- Thirty-nine high bleeding risk patients (mean age 77 years, CHA2DS2-VASc 5, HAS-BLED 3) were included.
- An initial 1-month DAPT strategy was revised to 6 months due to a device thrombosis complication.
- At 21-month follow-up, no strokes occurred, but 9 bleedings (4 major) were observed, all during DAPT.
- Post-procedure, patients transitioned to aspirin monotherapy, no therapy, or tailored regimens.
Conclusions:
- Antithrombotic therapy is crucial post-LAAO to prevent device thrombosis.
- DAPT in high bleeding risk patients is associated with significant bleeding complications.
- Further research is necessary to determine the optimal DAPT duration to minimize bleeding while maintaining efficacy.
Background:
Percutaneous left atrial appendage occlusion (LAAO) is an alternative to anticoagulation in atrial fibrillation patients at high bleeding risk. Dual antiplatelet therapy (DAPT) is generally recommended in the months following the procedure to prevent thrombotic complications. The aim of this study was to evaluate the safety and efficacy of DAPT after LAAO in a single-centre population of high bleeding risk patients.
Methods:
All patients who received DAPT after LAAO using the Amplatzer Cardiac Plug at Jessa Hospital (Hasselt, BE) between February 2011 and October 2016 were included. Patient characteristics, procedural outcome and clinical events (bleeding, stroke and adverse events) were prospectively followed. Changes in antithrombotic and/or anticoagulant regimens were assessed.
Results:
Thirty-nine patients (77 ± 7 years, 51% male, CHA2DS2-VASc 5(3-6), Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) 3(3-4)) were included. An initial strategy of one month DAPT (n = 2) was changed to six months DAPT (n = 37) after one thrombotic complication (device thrombosis) at 4.5 months. Post-procedural DAPT duration was 6.1 ± 3.7 months, after which aspirin monotherapy (62%), no antiplatelet/anticoagulant therapy (15%) or a tailored antithrombotic regimen was maintained. At mean follow-up of 21 ± 13 months, seven patients had died (18%), no strokes had occurred (0%) and nine bleedings of which four were major (10%). All major bleedings occurred within the first six months after the procedure during DAPT.
Conclusion:
Antithrombotic therapy after percutaneous LAAO is needed to prevent thrombotic complications, yet these impose bleeding complications in this high-risk population. Further efforts are needed to define the optimal duration of DAPT, aimed at reducing bleeding complications while maintaining a low thrombosis rate.
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