Related Experiment Video
Updated: Jan 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial
Josep Rodés-Cabau1,2,3, Luis Nombela-Franco4, Ignacio Cruz-Gonzalez5
1Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C., J.-M.P., J.C., P.V.-C., M.C., G.O., E.S.).
Insights
Direct oral anticoagulants (DOACs) did not significantly reduce device-related thrombosis after left atrial appendage closure (LAAC) compared to dual antiplatelet therapy (DAPT). However, DOACs demonstrated a superior safety profile with fewer adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Optimal antithrombotic strategy post-left atrial appendage closure (LAAC) is not established.
- Device-related thrombosis (DRT) is a significant complication following LAAC.
- This study aimed to compare anticoagulation and antiplatelet therapy for DRT prevention.
Purpose of the Study:
- To compare the efficacy of direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) in preventing device-related thrombosis (DRT) after LAAC.
- To evaluate the safety profiles of DOACs and DAPT in patients undergoing LAAC.
- To provide evidence for optimal antithrombotic treatment selection post-LAAC.
Main Methods:
- Prospective, multicenter, international randomized trial comparing DOACs and DAPT (aspirin+clopidogrel) for 60 days post-LAAC.
- Patients underwent transesophageal echocardiography at 60 days to assess for DRT.
- Primary outcome: DRT rate (per-protocol); Safety outcome: composite of mortality, stroke, bleeding, or DRT (intention-to-treat).
Main Results:
- DRT occurred in 1.5% of patients on DOACs vs. 4.1% on DAPT (P=0.110), failing to reach statistical significance.
- The composite safety outcome occurred in 22.5% of patients on DOACs vs. 34.9% on DAPT (P=0.003).
- Lower bleeding rates were observed in the DOAC group (17.4%) compared to the DAPT group (24.9%) (P=0.038).
Conclusions:
- DOACs did not significantly reduce DRT compared to DAPT after LAAC but offered an improved safety profile.
- Results should be interpreted cautiously due to statistical power limitations and narrower-than-expected differences.
- Larger studies are needed to confirm these findings and guide clinical practice.
Background:
The optimal antithrombotic treatment after transcatheter left atrial appendage closure (LAAC) remains to be determined. The objective of this trial was to compare anticoagulation and antiplatelet therapy for preventing device-related thrombosis (DRT) after LAAC.
Methods:
This was a prospective multicenter international randomized trial comparing 2 different antithrombotic strategies for preventing DRT after LAAC in patients with nonvalvular atrial fibrillation. Patients were randomized (1:1) to receive direct oral anticoagulants (DOACs) or dual antiplatelet therapy (DAPT; aspirin+clopidogrel) for 60 days. Patients underwent transesophageal echocardiography at 60 days, and the images were analyzed in a central echocardiography laboratory by experienced echocardiographers blinded to the allocated treatment. The primary outcome was DRT as determined by transesophageal echocardiography 60 days after LAAC in patients receiving the allocated treatment at the time of transesophageal echocardiography (per-protocol analysis). The safety outcome included all-cause mortality, stroke, bleeding, or site-reported DRT within 60 days after LAAC in all randomized patients (intention-to-treat analysis).
Results:
A total of 510 patients (mean age 77±9 years, 35% women) were included between October 2018 and May 2025, and 253 and 257 patients were randomized to the DOAC and DAPT groups, respectively. Of these, 399 patients underwent transesophageal echocardiography and were receiving the allocated treatment at 60 days after LAAC. The primary outcome occurred in 3 patients (1.5%) in the DOAC group compared with 8 patients (4.1%) in the DAPT group (difference, -2.7% [95% CI, -6.0% to 0.6%]; P=0.110). The safety outcome occurred in 52 patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in the DAPT group (difference, -12.4% [95% CI, -20.6% to -4.2%]; P=0.003), and differences were mainly driven by a lower rate of bleeding events in the DOAC group (44 patients [17.4%] versus 64 patients [24.9%]; difference, -7.5% [95% CI, -14.6% to -0.4%]; P=0.038).
Conclusions:
The use of DOACs after LAAC failed to reduce DRT compared with DAPT, but it was associated with an improved safety profile. The results of this study should be interpreted with caution because of statistical power issues related to the narrower-than-expected between-group differences and will need confirmation in future larger studies.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03568890.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Coronary Artery Disease V: Interprofessional Care