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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure

Jules Mesnier1, Ignacio Cruz-González2, Dabit Arzamendi3

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

The American Journal of Cardiology
|March 23, 2022
PubMed

Insights

Discontinuing antithrombotic treatment within six months after left atrial appendage closure (LAAC) is safe for many patients. Early discontinuation did not increase risks of death, stroke, or major bleeding in this study.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Research

Background:

  • Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke prevention in atrial fibrillation.
  • Antithrombotic treatment is standard post-LAAC, but its necessity and duration are debated, especially in high-risk bleeding patients.
  • Evidence on the safety of early antithrombotic treatment discontinuation after LAAC is limited.

Purpose of the Study:

  • To evaluate the safety and outcomes of early antithrombotic treatment discontinuation following successful LAAC.
  • To compare the risks of death, ischemic stroke, and major bleeding in patients with and without early antithrombotic treatment discontinuation.

Main Methods:

  • Multicenter study involving 1,082 patients who underwent successful LAAC.
  • Early discontinuation defined as stopping all antiplatelet/anticoagulant therapy within 6 months post-procedure.
  • Propensity-matched analysis comparing outcomes between patients with and without early discontinuation.

Main Results:

  • 13.7% of patients (148/1082) discontinued antithrombotic treatment early.
  • Patients discontinuing treatment had lower CHA2DS2-VASc scores and higher rates of prior gastrointestinal bleeding.
  • After a median follow-up of 2.1 years, propensity-matched analysis showed no significant difference in death, ischemic stroke, or major bleeding risk between groups.

Conclusions:

  • Early antithrombotic treatment discontinuation within 6 months after LAAC was not associated with increased adverse events in selected patients.
  • These findings support the safety of shorter antithrombotic therapy durations post-LAAC, guided by clinician judgment, particularly for high bleeding risk individuals.
  • Further clinical trials are warranted to confirm these outcomes.

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