DOAC After LAAC Beats DAPT Only in Observational Data
This meta-analysis suggests reduced-dose DOAC may outperform dual antiplatelet therapy after left atrial appendage closure, but the signal collapses when limited to randomized trials.
DOACs may outperform DAPT after LAAC in NVAF patients.
The optimal antithrombotic strategy after left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) remains uncertain, impacting patient outcomes. Direct oral anticoagulants (DOACs) reduced all-cause mortality, major bleeding, and device-related thrombosis compared to dual antiplatelet therapy (DAPT) in a pooled analysis; benefits were not statistically significant in randomized trials alone. DOACs may offer advantages over DAPT in terms of safety and efficacy after LAAC, but caution is advised as benefits were primarily observed in non-randomized studies. DOACs could reduce mortality and complications after LAAC but need further evidence from randomized trials.
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Executive Summary
Study Design
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