Anticoagulation versus antiplatelet therapy after percutaneous left atrial appendage closure-subanalysis from the...

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Research

Background:

• Percutaneous left atrial appendage (LAA) closure is an alternative to oral anticoagulation for stroke risk reduction in atrial fibrillation.
• Real-world data on post-procedural antithrombotic therapy following LAA closure are limited.
• Various LAA occluder systems are used, necessitating comparative outcome data.

Purpose of the Study:

• To compare anticoagulation (AC) versus antiplatelet therapy (APT) in real-world patients undergoing LAA closure.
• To evaluate the efficacy and safety of AC and APT regarding thrombotic and bleeding events.
• To provide insights into antithrombotic strategies in a diverse, unselected patient population.

Main Methods:

• Analysis of data from the multi-center LAARGE study, a real-world registry.
• Patients were assigned to either AC or APT based on initial post-implantation antithrombotic regimen.
• Outcomes were assessed 1-year post-LAA closure, focusing on a composite of death, stroke, systemic embolism, and bleeding events.

Main Results:

• A total of 627 patients were included; 12% received AC and 88% received APT.
• No significant differences were observed in the composite endpoint of death, stroke, and systemic embolism at 1 year (9.4% for AC vs. 12.8% for APT; p=0.45).
• Bleeding complication rates were also comparable between the AC and APT groups (any bleeding 8.0% vs. 6.9%; p=0.73).

Conclusions:

• Post-procedural antithrombotic treatment with AC and APT demonstrates comparable efficacy and safety profiles after LAA closure.
• These findings support the use of either AC or APT in real-world, all-comers populations undergoing LAA closure.
• The choice of antithrombotic therapy can be individualized based on patient-specific factors and physician discretion.