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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Early discontinuation of antithrombotic therapy following left atrial appendage closure: a systematic review and
Pablo Vidal-Calés1, Quentin Battistolo1, Maxim Ruel1
1Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Insights
Early cessation of antithrombotic therapy (AT) after left atrial appendage closure (LAAC) appears safe for high-bleeding-risk patients. Discontinuing AT before six months did not increase stroke or death risk in this meta-analysis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Optimal antithrombotic therapy (AT) post-left atrial appendage closure (LAAC) is unclear, especially for high-bleeding-risk patients.
- Early AT cessation (<6 months) is increasingly common but lacks robust evidence.
Purpose of the Study:
- To evaluate the safety of early (<6 months) complete discontinuation of AT after LAAC.
- To assess the association between early AT cessation and adverse events.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Searched PubMed and Scopus through September 2025.
- Primary endpoint: stroke; secondary endpoints: mortality, major bleeding, device-related thrombus (DRT).
Main Results:
- Analyzed 7 studies with 1841 patients (529 early AT cessation).
- Early AT cessation in high-risk patients was not linked to increased stroke (RR 1.04), death (RR 1.03), major bleeding (RR 1.22), or DRT (RR 0.49).
- No significant difference between very early (<1 month) and early (<6 months) cessation.
Conclusions:
- Early AT discontinuation is potentially safe regarding thromboembolic events and death in high-bleeding-risk LAAC patients.
- Supports cautious early AT cessation in selected patients.
- Randomized trials are needed for definitive evidence.
Objectives:
Optimal postprocedural antithrombotic management after left atrial appendage closure (LAAC) remains undefined, particularly in patients with high bleeding risk. Early complete cessation (<6 months) of antithrombotic therapy (AT) following LAAC is increasingly adopted, yet supportive evidence is limited. This study sought to evaluate the safety of early (<6 months) complete discontinuation of AT after LAAC.
Methods:
A systematic review and meta-analysis of observational studies was conducted. PubMed and Scopus were searched through September 2025. The primary endpoint was stroke events; secondary endpoints included all-cause mortality, major bleeding, and device-related thrombus (DRT). Random-effects models were used to calculate pooled risk ratios (RRs). Subgroup and sensitivity analyses were performed.
Results:
Seven studies including 1841 patients (529 with early AT cessation) were analyzed. Patients undergoing early AT discontinuation exhibited high baseline thromboembolic and bleeding risk, and most of them (67%) had prior bleeding events. Over a weighted mean follow-up of 19.2 months, early discontinuation of AT was not associated with increased risk of stroke (RR, 1.04; 95% CI, 0.40-2.66), all-cause death (RR, 1.03; 95% CI, 0.49-2.17), major bleeding (RR, 1.22; 95% CI, 0.75-2.01), or DRT (RR, 0.49; 95% CI, 0.14-1.73). No significant differences were observed between very early (<1 month) and early (<6 months) cessation strategies.
Conclusions:
Among high-bleeding-risk patients undergoing LAAC, early complete discontinuation of AT was not associated with an increased risk of thromboembolic events or death during mid-term follow-up. These results support the potential ischemic safety of early antithrombotic cessation in carefully selected patients and highlight the need for definite evidence from randomized trials.
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