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Published on: February 26, 2013
Safety and Efficacy of Single Versus Dual Antiplatelet Therapy After Left Atrial Appendage Occlusion
Giuseppe Patti1, Alessandro Sticchi2, Giuseppe Verolino2
1University of Eastern Piedmont and Maggiore della Carità Hospital, Novara, Italy.
Insights
Single antiplatelet therapy (SAPT) after left atrial appendage (LAA) occlusion is as effective as dual antiplatelet therapy (DAPT) for preventing major adverse events. SAPT significantly reduces bleeding complications without increasing thrombotic event risk, suggesting it may be a safer alternative.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- The optimal antiplatelet strategy post-left atrial appendage (LAA) occlusion remains unclear.
- Balancing device-related thrombosis prevention with bleeding risk is crucial.
- Current guidelines lack definitive recommendations for antiplatelet therapy duration and type after LAA occlusion.
Purpose of the Study:
- To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) after LAA occlusion.
- To evaluate the impact of SAPT vs. DAPT on a composite endpoint of bleeding and ischemic events.
- To determine if SAPT can reduce bleeding complications without compromising thrombotic event prevention.
Main Methods:
- Real-world, observational, head-to-head comparison of SAPT and DAPT in 610 patients undergoing LAA occlusion.
- Patients were stratified into SAPT (n=280) and DAPT (n=330) groups.
- Primary outcome: Net composite endpoint including Bleeding Academic Research Consortium (BARC) 3-5 bleeding, major adverse cardiovascular events (MACE), or device-related thrombosis at 1-year follow-up.
Main Results:
- SAPT and DAPT showed similar rates of the primary net composite endpoint (9.3% vs. 12.7%, p=0.22).
- SAPT significantly reduced BARC 3-5 bleeding compared to DAPT (2.9% vs. 6.7%, p=0.038).
- Ischemic event rates (MACE or device-related thrombosis) were comparable between SAPT and DAPT groups (7.8% vs. 7.4%, p=0.38).
Conclusions:
- Post-procedural SAPT following LAA occlusion is associated with reduced bleeding complications compared to DAPT.
- SAPT demonstrates comparable efficacy to DAPT in preventing thrombotic events after LAA occlusion.
- These findings suggest SAPT may be a viable alternative to DAPT, warranting confirmation in randomized trials.
Abstract:
The optimal antiplatelet strategy after left atrial appendage (LAA) occlusion able to protect from device-related thrombosis, paying the lowest price in terms of bleeding increase, is unclear. In a real-world, observational study we performed a head-to-head comparison of single versus dual antiplatelet therapy (SAPT vs DAPT) in patients who underwent LAA occlusion. We included 610 consecutive patients, stratified according to the type of post-procedural antiplatelet therapy (280 on SAPT and 330 on DAPT). Primary outcome measure was the incidence of the net composite end point including Bleeding Academic Research Consortium classification 3-5 bleeding, major adverse cardiovascular events or device-related thrombosis at 1-year follow-up. The use of SAPT compared with DAPT was associated with similar incidence of the primary net composite end point (9.3% vs 12.7% p = 0.22), with an adjusted hazard ratio (HR) of 0.69, 95% confidence interval 0.41 to 1.15; p = 0.15) at multivariate analysis. However, SAPT significantly reduced Bleeding Academic Research Consortium classification 3-5 bleeding (2.9% vs 6.7%, p = 0.038; adjusted HR 0.37, 0.16 to 0.88; p = 0.024). The occurrence of ischemic events (major adverse cardiovascular events or device-related thrombosis) was not significantly different between the 2treatment strategies (7.8% vs 7.4%; adjusted HR 1.34, 0.70 to 2.55; p = 0.38). In patients who underwent LAA occlusion, post-procedural use of SAPT instead of DAPT was associated with reduction of bleeding complications, with no significant increase in the risk of thrombotic events. These hypothesis-generating findings should be confirmed in a specific, randomized study.
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