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Updated: Jun 4, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Single vs dual antiplatelet therapy after left atrial appendage closure: A propensity score matching analysis
Roberto Galea1, Juan Perich Krsnik2, Tommaso Bini2
1Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Hospital Centre of Biel, Biel, Switzerland.
Insights
Single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) showed similar ischemic and bleeding outcomes after left atrial appendage closure (LAAC). This suggests SAPT may be a viable alternative for patients at high bleeding risk post-LAAC.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Management
Background:
- Current guidelines recommend dual antiplatelet therapy (DAPT) or oral anticoagulation post-left atrial appendage closure (LAAC).
- Patients undergoing LAAC often have high bleeding risk, necessitating exploration of less intensive antithrombotic strategies.
- Single antiplatelet therapy (SAPT) is a potential alternative to DAPT in this population.
Purpose of the Study:
- To compare ischemic and bleeding outcomes between SAPT and DAPT following successful LAAC.
- To evaluate the safety and efficacy of reduced antithrombotic intensity after LAAC.
Main Methods:
- Prospective data collection from LAAC patients (2009-2023) with 1-year follow-up.
- Propensity score matching to compare patients on SAPT versus DAPT.
- Primary endpoint: 1-year composite of cardiovascular death, stroke, systemic embolism, or device-related thrombosis (DRT).
- Secondary endpoints: major bleeding and DRT.
Main Results:
- 154 SAPT patients were matched with 230 DAPT patients.
- No significant difference in the primary endpoint between SAPT and DAPT groups (11.0% vs 8.3%, P = .420).
- Major bleeding rates were similar (9.7% vs 12.6%, P = .387), as were DRT rates (2.6% vs 1.1%, P = .130).
Conclusions:
- Ischemic and bleeding outcomes at 1 year were comparable for SAPT and DAPT after LAAC in this propensity score-matched cohort.
- SAPT may be a suitable alternative for select patients post-LAAC, particularly those with high bleeding risk.
- Further confirmation in large, randomized clinical trials is warranted.
Background:
Dual antiplatelet therapy and oral anticoagulation in combination with aspirin represent recommended treatment regimens after left atrial appendage closure (LAAC). As most patients receiving LAAC have high bleeding risk, less aggressive antithrombotic treatments are needed, such as single antiplatelet therapy.
Objective:
We sought to compare both ischemic and bleeding outcomes in patients receiving single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) after successful LAAC.
Methods:
Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2023 were prospectively collected including 1-year follow-up. Propensity score matching was performed for patients discharged under SAPT and DAPT. The primary end point was the 1-year composite of cardiovascular death, stroke, systemic embolism, or device-related thrombosis (DRT). The secondary end points included major bleeding and DRT.
Results:
Of 1033 patients discharged with antiplatelet therapy, 154 patients receiving SAPT were compared with 230 matched patients receiving DAPT. The primary end point was similar between the study groups (SAPT 11.0% vs DAPT 8.3%; rate ratio, 1.14; 95% confidence interval [CI], 0.83-1.55; P = .420). Consistently, we found no difference in terms of both major bleeding (SAPT 9.7% vs DAPT 12.6%; hazard ratio, 0.77; 95% CI, 0.43-1.39; P = .387) and DRT (2.6% vs 1.1%; rate ratio, 1.47; 95% CI, 0.89-2.43; P = .130) between the SAPT and DAPT groups.
Conclusion:
In this propensity score matching analysis of a single-center LAAC cohort, ischemic and bleeding outcomes did not differ at 1 year for patients discharged with SAPT or DAPT. These results have to be confirmed in an adequately powered randomized clinical trial.
