Antithrombotic strategies after interventional left atrial appendage closure: an update

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention in non-valvular atrial fibrillation (AF).
• Optimizing antithrombotic therapy post-LAAO is crucial for device endothelialization, balancing thromboembolic and bleeding risks.

Purpose of the Study:

• To review recent clinical trials on antithrombotic therapy following interventional LAAO.
• To discuss current real-world antithrombotic strategies after LAAO device implantation.

Main Methods:

• Review of recent clinical trials.
• Discussion of real-world antithrombotic strategies post-LAAO.

Main Results:

• For Watchman devices, evidence supports warfarin plus aspirin, followed by dual antiplatelet therapy (DAPT), then lifelong aspirin.
• Real-world practice often involves 3-6 months of DAPT or 3 months of novel oral anticoagulation (NOAC) with aspirin for Watchman.
• DAPT for 1-6 months is common for other LAAO devices.
• Short-term DAPT (6 weeks) or aspirin monotherapy may be suitable, given bleeding is a primary complication.

Conclusions:

• Antithrombotic strategies after LAAO require careful consideration of individual patient risks.
• Evidence supports various DAPT durations and single antiplatelet therapy as potential options.
• Further research may refine optimal antithrombotic regimens to minimize complications.