Arrhythmias & electrophysiology
Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion: a network meta-analysis
Pooled result · Major bleedingResult — go to the resultOdds ratio 0.45 95% CI 0.22–0.92Authors' conclusion
DOACs provide a superior safety-efficacy profile compared with other antithrombotic strategies following LAAO, significantly reducing the risks of major bleeding, thromboembolic events, and mortality. While low-dose DOACs may offer additional bleeding risk reduction without compromising efficacy, further research is warranted to confirm their role in clinical practice.
Study context
- Population
- Patients with non-valvular atrial fibrillation undergoing percutaneous left atrial appendage occlusion (LAAO)52 studies (49 observational and 3 randomized controlled trials (RCTs)) · observational studies 49 · RCTs 3
- Participants
- 69,751 patients
- Comparison
- Various antithrombotic strategies, including DOAC dosing, following LAAO
- Outcome
- Major bleeding and thromboembolism
Methodological detailsrandomized controlled trials and observational studies, random-effects model, Cochrane and PRISMA guidelines
- Randomized controlled trials and observational studies
- Random-effects model
- Cochrane and PRISMA guidelines
Pooled result
Major bleeding
Odds ratio
0.45
95% CI 0.22–0.92
Low-dose DOACsvs standard-dose DOACs
odds ratio 0.45 (95% CI 0.22–0.92)
As reported in the abstract
Further pooled results
Device-related thrombosis (DRT) and all-cause mortality (secondary outcomes)
- Direct oral anticoagulants (DOACs) associated with significantly lower all-cause mortality than other antithrombotic regimens
- DRT: standard-dose DOAC significantly reduced risk compared with single antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT); low-dose DOAC significantly reduced risk compared with SAPT, DAPT, and vitamin K antagonists plus SAPT
Ranking analysis
- DOACs emerged as the most effective and safest antithrombotic strategy, with low-dose DOACs demonstrating further safety benefits in bleeding outcomes
Original publication
Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion: a network meta-analysis. Eur Heart J Cardiovasc Pharmacother. Published 25 November 2025. doi:10.
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