In contemporary practice after LAAO, reduced-dose DOAC therapy was associated with more favourable outcomes than DAPT but showed no clear advantage over SAPT, supporting simplified and individualised post-implantation antithrombotic strategies.
Reduced-dose DOAC was associated with lower all-cause mortality compared to DAPT after LAAO.
Reduced-dose DOAC was associated with lower major bleeding risk compared to DAPT after LAAO.
Reduced-dose DOAC showed no statistically significant advantage over SAPT in any major outcome category after LAAO.
SAPT was associated with fewer bleeding events and more favourable outcomes compared with DAPT after LAAO.
The study used a large real-world database to identify adult patients with atrial fibrillation who underwent percutaneous LAAO between 2010 and 2025.
This research examined what type of blood-thinning medication works best after a procedure called left atrial appendage occlusion (LAAO), which is used in people with atrial fibrillation (an irregular heart rhythm) to reduce stroke risk by closing off a small pouch in the heart where clots commonly form. After the LAAO procedure, doctors have been uncertain whether to prescribe anticoagulants (blood thinners that prevent clotting), antiplatelet drugs (which prevent platelets from sticking together), or some combination. This study compared three strategies: a low-dose version of newer anticoagulants called direct oral anticoagulants (DOACs), dual antiplatelet therapy (two antiplatelet drugs together), and single antiplatelet therapy (one antiplatelet drug). Using a large international medical records database covering patients treated between 2010 and 2025, the researchers found that low-dose DOAC therapy led to fewer deaths and less major bleeding compared to dual antiplatelet therapy, with no meaningful differences in stroke or device-related clot formation. However, when low-dose DOACs were compared to single antiplatelet therapy alone, there was no clear winner — the two strategies performed similarly across most outcomes, though there was a suggestion (not quite statistically significant) that DOACs might carry a slightly higher bleeding risk than single antiplatelet therapy. This research suggests that simpler antithrombotic regimens — either a low-dose DOAC or a single antiplatelet drug — may be preferable to dual antiplatelet therapy after LAAO, and that the choice between the two simpler options may depend on individual patient factors. The findings support a move away from the more aggressive dual antiplatelet approach that has historically been common after this procedure, though the authors note that antithrombotic decisions should be individualized for each patient.
Fauchier L, Nasarre M, Pierre B, Bisson A, Lip G. (2026). Reduced-dose direct oral anticoagulant versus antiplatelet strategies after left atrial appendage occlusion.. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. https://doi.org/10.4244/EIJ-D-26-00102