Short-term direct oral anticoagulation or dual antiplatelet therapy following left atrial appendage closure in patients with relative contraindications to chronic anticoagulation therapy

• Published in: International journal of cardiology 2021-06, Vol.333, p.77-82
• Main Authors: Faroux, Laurent, Cruz-González, Ignacio, Arzamendi, Dabit, Freixa, Xavier, Nombela-Franco, Luis, Peral, Vicente, Caneiro-Queija, Berenice, Mangieri, Antonio, Trejo-Velasco, Blanca, Asmarats, Lluis, Regueiro, Ander, McInerney, Angela, Mas-Lladó, Caterina, Estevez-Loureiro, Rodrigo, Laricchia, Alessandra, O'Hara, Gilles, Rodés-Cabau, Josep
• Format: Article
• Language: English
• Subjects: Antiplatelet therapy; Atrial fibrillation; Direct oral anticoagulant; Left atrial appendage closure; Stroke
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.02.054

Biological data suggest that short-term anticoagulation would be more effective than dual antiplatelet therapy (DAPT) to reduce the thrombotic risk following left atrial appendage closure (LAAC). This study sought to assess the safety and efficacy of direct oral anticoagulation (DOAC) versus DAPT immediately post-LAAC. Multicenter study including 592 consecutive patients with relative contraindication to chronic anticoagulation who underwent LAAC and received either DAPT or DOAC for 1–3 months. Each patient receiving DOAC was matched with 2 patients on DAPT based on propensity-score (propensity-matched population of 285 patients). Outcomes recorded were death, stroke, non-procedural related severe bleeding, serious adverse event (SAE: composite of death, stroke, bleeding) and early (within 3 months post-LAAC) device-related thrombosis (DRT). Early outcomes (within 3-month post-LAAC) did not significantly differ between groups, but a numerically higher rate of early death (3.7% vs. 1.1%), non-procedural related severe bleeding (7.4% vs. 3.2%), and SAE (11.1% vs. 5.3%) were observed in patients receiving DAPT. After a median follow-up of 22 (8–38) months, similar outcomes were observed in DAPT and DOAC groups regarding death (HR: 1.18; 95% CI: 0.58–2.37; p = 0.652), stroke (HR: 1.01; 95% CI: 0.22–5.45; p = 0.908), non-procedural related severe bleeding (HR: 1.68; 95% CI: 0.69–4.12; p = 0.257), and SAE (HR: 1.28; 95% CI: 0.73–2.24; p = 0.383). DRT was identified in 4 patients (2.6%) receiving DAPT versus 0 patient receiving DOAC (p = 0.162). Short-term DOAC following LAAC in patients with contraindications to chronic anticoagulation was safe and tended to associate with a lower rate of SAE and DRT compared to DAPT. •In patients with contraindications to chronic oral anticoagulation therapy undergoing left atrial appendage closure, the use of short-term direct oral anticoagulant was associated with a tendency towards a lower rate of early bleeding events and device-related thrombosis as compared to dual antiplatelet therapy.•The risk of ischemic stroke post-left atrial appendage closure was low and similar between direct oral anticoagulant and dual antiplatelet therapy groups.