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Updated: Jul 16, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network
Li-Man Wang1,2, Yan Chen1,2, Li-Li Xu1,2
1Department of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, China.
Insights
Optimal antithrombotic therapy after left atrial appendage occlusion (LAAO) is debated. This study found no significant differences in stroke, device-related thrombus, or bleeding among dual antiplatelet therapy, direct oral anticoagulants, and vitamin K antagonists, though VKAs were preferred.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous left atrial appendage occlusion (LAAO) is a stroke prevention strategy for nonvalvular atrial fibrillation (NVAF).
- Antithrombotic therapy is crucial post-LAAO, but optimal regimens remain unclear.
- This study compares antithrombotic strategies following LAAO procedures.
Purpose of the Study:
- To compare the safety and efficacy of different antithrombotic strategies after LAAO.
- To evaluate outcomes including stroke, device-related thrombus (DRT), and major bleeding.
- To provide evidence-based recommendations for post-LAAO antithrombotic management.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and Cochrane Library.
- Network meta-analysis of observational studies comparing dual antiplatelet therapy (DAPT), direct oral anticoagulants (DOACs), and vitamin K antagonists (VKAs).
- Risk ratios and surface under the cumulative ranking curve (SUCRA) were calculated for efficacy and safety outcomes.
Main Results:
- Ten observational studies with 1,674 patients were analyzed.
- No significant differences in stroke, DRT, or major bleeding were observed among DAPT, DOACs, and VKAs.
- DAPT showed the worst ranking for stroke, DRT, and bleeding (SUCRA < 20%), while VKAs were ranked highest for stroke and DRT prevention.
Conclusions:
- No significant differences in key outcomes exist between DAPT, DOACs, and VKAs post-LAAO.
- DAPT is associated with higher risks, while VKAs appear preferable based on SUCRA analysis.
- DOACs warrant consideration due to their convenience, despite slightly lower SUCRA rankings for stroke and DRT compared to VKAs.
Abstract:
Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a stroke prevention strategy in patients with nonvalvular atrial fibrillation (NVAF), and these patients were required to receive antithrombotic therapy post-procedure. However, the optimal antithrombotic strategy after LAAO remains controversial. This study explored the safety and efficacy of different antithrombotic strategies after LAAO through a network comparison method. Methods: We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies that reported the interested efficacy and safety outcomes (stroke, device-related thrombus (DRT), and major bleeding) of different antithrombotic strategies [DAPT (dual antiplatelet therapy), DOACs (direct oral anticoagulants), and VKA (vitamin k antagonist)] in patients who had experienced LAAO. Pairwise comparisons and network meta-analysis were performed for the interested outcomes. Risk ratios (RRs) with their confidence intervals (CIs) were calculated using a random-effects model. The rank of the different strategies was calculated using the surface under the cumulative ranking curve (SUCRA). Results: Finally, 10 observational studies involving 1,674 patients were included. There was no significant difference in stroke, DRT, and major bleeding among the different antithrombotic strategies (DAPT, DOACs, and VKA). Furthermore, DAPT ranked the worst in terms of stroke (SUCRA: 19.8%), DRT (SUCRA: 3.6%), and major bleeding (SUCRA: 6.6%). VKA appeared to be superior to DOACs in terms of stroke (SUCRA: 74.9% vs. 55.3%) and DRT (SUCRA: 82.3% vs. 64.1%) while being slightly inferior to DOACs in terms of major bleeding (SUCRA: 71.0% vs. 72.4%). Conclusion: No significant difference was found among patients receiving DAPT, DOACs, and VKA in terms of stroke, DRT, and major bleeding events after LAAO. The SUCRA indicated that DAPT was ranked the worst among all antithrombotic strategies due to the higher risk of stroke, DRT, and major bleeding events, while VKAs were ranked the preferred antithrombotic strategy. However, DOACs are worthy of consideration due to their advantage of convenience.
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