Arrhythmias & electrophysiologyResearch article
Reduced-dose direct oral anticoagulant versus antiplatelet strategies after left atrial appendage occlusion
- Three parallel propensity score-matched analyses
- TriNetX Global Network
Authors' conclusion
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.
Study context
- Population
- Adult patients with atrial fibrillation (AF) who underwent percutaneous left atrial appendage occlusion (LAAO) between 2010 and 2025patients per group in the reduced-dose direct oral anticoagulation (DOAC) versus dual antiplatelet therapy (DAPT) comparison after matching, 1,582 matched patients per group in the reduced-dose DOAC versus single antiplatelet therapy (SAPT) comparison · reduced-dose DOAC versus DAPT, per group 1,773 · reduced-dose DOAC versus SAPT, per group 1,582
- Participants
- 1,773 patients
- Comparison
- reduced-dose DOAC vs DAPT
Main finding
All-cause death · mean follow-up 1.4±1.0 years
Hazard ratio
0.79
95% CI 0.65–0.96
reduced-dose DOAC vs DAPT
HR 0.79 (95% CI 0.65–0.96)
As reported in the abstract
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Net clinical benefit (NCB) · NCB favoured reduced-dose DOAC | 0.87 (0.78–0.96) | |
| 0.512Hazard ratio (log scale) |
Ischaemic stroke, thromboembolism, device-related thrombosis (reduced-dose DOAC vs DAPT)
- No significant differences
Bleeding events and outcomes (SAPT vs DAPT)
- SAPT associated with fewer bleeding events and favourable outcomes compared with DAPT
Mortality, thromboembolic outcomes, net clinical benefit (NCB) (reduced-dose DOAC vs SAPT)
- Did not differ significantly
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding (reduced-dose DOAC vs DAPT) · lower risk with reduced-dose DOAC | 0.87 (0.77–0.98) | ||
| Major bleeding (reduced-dose DOAC vs SAPT) | 1.14 (1.00–1.30) | P = 0.06 | |
| 0.512Hazard ratio (log scale) |
- Major bleeding (reduced-dose DOAC vs SAPT): estimates compatible with a slightly higher risk with reduced-dose DOAC
- Major bleeding (reduced-dose DOAC vs SAPT): 1,582 matched patients per group
Original publication
Reduced-dose direct oral anticoagulant versus antiplatelet strategies after left atrial appendage occlusion. EuroIntervention. Published 7 September 2026. doi:10.4244/eij-d-26-00102
Summarised from the published abstract; every number is checked against it