In patients undergoing left atrial appendage occlusion, DOAC therapy significantly reduced the risk of device-related thrombus compared to DAPT (OR 0.35; 95% CI 0.19-0.1.64; p=0.001).
Meta-Analysis (n=23,741)
Does DOAC therapy reduce device-related thrombus, stroke, bleeding, and mortality compared to DAPT in patients with atrial fibrillation after LAAO?
In patients undergoing LAAO, short-term DOAC therapy is associated with lower risks of device-related thrombus and major bleeding compared to DAPT, without significant differences in stroke or mortality.
Odds Ratio: 0.35 (95% CI 0.19–1.64)
p-value: p=0.001
Introduction: Atrial Fibrillation is one of the leading causes of ischemic stroke globally. Left Atrial Appendage Occlusion (LAAO) serves as a standard alternative to long-term anti-coagulation in atrial fibrillation patients who are at increased bleeding risk or unable to tolerate antithrombotic therapy. However, they remain at risk of thrombotic complications and ischemic stroke. At present, there are no strict guidelines regarding the optimal short-term therapy after LAAO in patients with atrial fibrillation. Objective: To compare the efficacy of DOAC for stroke prevention and device-related thrombus after LAAO in atrial fibrillation as compared to DAPT therapy. Methods: We performed a thorough literature search of databases including PubMed, Embase, and Cochrane from inception till 31st July 2025. Eligible studies included patients on DOACs versus DAPT LAAO. Primary outcomes included device-related thrombus, Ischemic Stroke or TIA, major bleeding, and all-cause mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Analysis was performed in Comprehensive Meta-Analysis (CMA) software. Results: A total of 9 studies (RCTs and observational studies) were included in this meta-analysis, enrolling 17,167 patients receiving DOAC and 6,574 patients receiving DAPT. The mean CHA2DS2-VASc score was similar across groups (4.2 in DOAC vs 4.3 in DAPT). Atrial or Device-related thrombus was reported in 9 studies; DOAC was associated with a significantly lower risk compared with DAPT (OR 0.35, 95% CI 0.19–0.1.64; p = 0.001). Ischemic Stroke or TIA was reported in 5 studies, and no significant difference was observed (OR 0.794, 95% CI 0.48–1.129; p = 0.118). Major bleeding was reported in 6 studies, and we found that DOAC use was associated with a significantly lower risk compared with DAPT (OR 0.52, 95% CI 0.39–0.69; p < 0.001). Mortality was reported in 4 studies; no significant difference was observed (OR 1.05, 95% CI 0.45–2.43; p = 0.916). Conclusion: In patients undergoing LAAO, DOAC therapy was associated with lower risks of device-related thrombus and major bleeding compared with DAPT, without significant differences in the risk of stroke/TIA or mortality. These findings suggest DOACs can provide a safer antithrombotic strategy following LAAO. However, further randomized controlled studies are required to determine the ideal therapy and doses.
Asmar et al. (2026) conducted a meta-analysis in Atrial Fibrillation (n=23,741). Direct Oral Anti-Coagulants (DOACs) vs. Dual Anti-Platelet Therapy (DAPT) was evaluated on Atrial or Device-related thrombus (OR 0.35, 95% CI 0.19-0.1.64, p=0.001). In patients undergoing left atrial appendage occlusion, DOAC therapy significantly reduced the risk of device-related thrombus compared to DAPT (OR 0.35; 95% CI 0.19-0.1.64; p=0.001).