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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Antithrombotic Management After Left Atrial Appendage Closure: Current Evidence and Future Perspectives

Jules Mesnier1, Pedro Cepas-Guillén2, Xavier Freixa2

  • 1Quebec Heart and Lung Institute, Laval University, Québec City, Canada (J.M., K.H.T., G.O., J.R.-C.).

Circulation. Cardiovascular Interventions
|May 16, 2023
PubMed

Insights

Optimal antithrombotic therapy after left atrial appendage closure is crucial for preventing device-related thrombosis and minimizing bleeding. This review analyzes evidence to guide treatment choices for nonvalvular atrial fibrillation patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Management

Background:

  • Left atrial appendage closure (LAAC) offers an alternative to oral anticoagulation for preventing embolic events in nonvalvular atrial fibrillation (NVAF).
  • Post-LAAC antithrombotic therapy is essential to prevent device-related thrombosis (DRT), a serious complication linked to ischemic events.
  • The ideal antithrombotic strategy balancing DRT prevention and bleeding risk after LAAC remains undetermined.

Purpose of the Study:

  • To review and analyze existing evidence on various antithrombotic regimens used after LAAC.
  • To provide guidance for clinicians in selecting optimal antithrombotic treatments post-LAAC.
  • To discuss future research directions in antithrombotic therapy following LAAC.

Main Methods:

  • Comprehensive literature review of observational studies and clinical experiences with LAAC.
  • Analysis of antithrombotic treatment strategies and their outcomes (thrombosis, bleeding, ischemic events).
  • Synthesis of data to evaluate the efficacy and safety of different antithrombotic regimens.

Main Results:

  • A wide spectrum of antithrombotic treatments has been employed over a decade of LAAC experience.
  • Evidence primarily stems from observational data, highlighting variability in treatment protocols.
  • No definitive consensus exists on the optimal regimen balancing thrombosis prevention and bleeding risk.

Conclusions:

  • Current evidence is largely based on observational data, necessitating further high-quality research.
  • Physician choice of antithrombotic therapy post-LAAC requires careful consideration of individual patient risk factors.
  • Future studies should focus on establishing evidence-based guidelines for antithrombotic management after LAAC.

Keywords:
anticoagulantsatrial appendageatrial fibrillationstroke, thrombosisthromboembolism

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