Arrhythmias & electrophysiologyMeta-analysis
Direct oral anticoagulants vs dual antiplatelet therapy following left atrial appendage closure in atrial fibrillation
- meta-analysis
Authors' conclusion
In randomized trials of patients with AF undergoing LAAC, short-term DOAC-based regimens were associated with lower rates of DRT and fewer bleeding events than DAPT, without differences in stroke or mortality. These findings support DOACs as a favorable short-term antithrombotic option after LAAC in selected patients.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage closure (LAAC)3 randomized controlled trials (RCTs) (ADRIFT, ADALA, ANDES)
- Participants
- 704 patients
- Comparison
- Direct oral anticoagulants (DOACs) vs dual antiplatelet therapy (DAPT) in the early post-implant period following LAAC
- DOACn = 368
- DAPTn = 336reference
Pooled result
Device-related thrombosis (DRT) · 2-3 months
Odds ratio
0.16
95% CI 0.05–0.57
DOAC vs DAPT
OR 0.16 (95% CI 0.05–0.57)
As reported in the abstract
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| Stroke · 2-3 months · no significant difference | 0.46 (0.07–3.13) | |
| All-cause mortality · 2-3 months · no significant difference | 0.60 (0.23–1.54) | |
| 0.050.21520Odds ratio (log scale) |
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Major bleeding · 2-3 months · lower with DOACs | 0.46 (0.26–0.81) | |
| Minor bleeding · 2-3 months · lower with DOACs | 0.59 (0.38–0.92) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Direct oral anticoagulants vs dual antiplatelet therapy following left atrial appendage closure in atrial fibrillation. Heart Rhythm. Published 17 April 2026. doi:10.1016/j.hrthm.2026.04.020
Summarised from the published abstract; every number is checked against it