Antithrombotic Therapy After Percutaneous Left Atrial Appendage Closure: Results From the TERMINATOR Registry

Although warfarin plus aspirin as an antithrombotic regimen after percutaneous left atrial appendage closure (LAAC) has been proposed in initial randomized trials, other regimens are often used in real-world settings because of differences in patient characteristics and the widespread use of direct oral anticoagulant agents (DOACs). However, variations in antithrombotic regimens after LAAC and their impact on major adverse events remain unclear in Asian patients, who have a higher risk for bleeding and a lower risk for ischemic events than non-Asian patients.

The aim of this study was to investigate variations in antithrombotic regimens after LAAC and the impact of these regimens on major adverse events.

A total of 1,449 patients who underwent LAAC between August 2019 and May 2023 were analyzed in a multicenter, observational, real-world registry from Japan. The outcomes were the antithrombotic regimens at discharge and major adverse events at 6 months according to these regimens. Covariate adjustment using propensity scores was performed to compare the impact of antithrombotic regimens on major adverse events.

Median follow-up duration was 184 days (Q1-Q3: 174-195 days). The 5 most common antithrombotic regimens at discharge were DOAC only (32.4% [469 of 1,449]), DOAC and aspirin (30.3% [439 of 1,449]), warfarin and aspirin (13.7% [199 of 1,449]), DOAC and P2Y₁₂ inhibitor (10.4% [151 of 1,449]), and warfarin only (6.2% [90 of 1,449]). Differences in the antithrombotic regimens were not significantly associated with major adverse events after covariate adjustment.

In a real-world registry from Japan, the initial antithrombotic regimen after LAAC was not commonly used, and differences in antithrombotic regimens did not significantly affect short-term clinical outcomes. (Transcatheter Modification of Left Atrial Appendage by Obliteration With Device in Patients With NVAF [TERMINATOR]; UMIN000044934.