What question did this study set out to answer?

To evaluate the efficacy and clinical safety of stopping antithrombotic therapy within six months after left atrial appendage occlusion (LAAO) in atrial fibrillation patients at high risk of bleeding.

July 16, 2025Catheterization and Cardiovascular Interventions

Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients

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Why the study?

Patients undergoing LAAO are typically at high bleeding risk, and the optimal post-implantation antithrombotic regimen remains debated.

Does a maximum 6-month course of antithrombotic therapy followed by complete cessation prevent stroke or TIA in high bleeding risk patients with atrial fibrillation post-LAAO?

Key Points

To evaluate the efficacy and clinical safety of stopping antithrombotic therapy within six months after left atrial appendage occlusion (LAAO) in atrial fibrillation patients at high risk of bleeding.
Retrospective analysis of patients undergoing LAAO between 2015 and 2024 at a single center who were discharged on a maximum six-month antithrombotic regimen.
Tracked clinical outcomes over 484 patient-years (median follow-up of 3.6 years) for incidence of stroke, transient ischemic attack (TIA), major bleeding, and overall mortality.
Complete closure of the left atrial appendage was achieved in 116 patients (90.6%), and 126 patients (98.4%) received antiplatelet monotherapy for six months or less.
Stroke or TIA occurred in 5.5% of patients (1.45 per 100 patient-years), representing a 69% reduction compared to predicted risk.
Major bleeding occurred in 10.2% of patients (2.69 per 100 patient-years), while overall mortality reached 36.7% (9.71 per 100 patient-years).

Structured PICO

Does a maximum 6-month course of antithrombotic therapy followed by complete cessation prevent stroke or TIA in high bleeding risk patients with atrial fibrillation post-LAAO?

Population

High bleeding risk patients with atrial fibrillation who underwent left atrial appendage occlusion (LAAO) and were discharged on a plan of 6 months antithrombotic therapy (N=128).

Intervention

Maximum of 6-month antithrombotic treatment (predominantly antiplatelet therapy only) post-LAAO, followed by complete cessation.

Comparator

Predicted risk (no active control group).

Outcome

Incidence of stroke, transient ischaemic attack (TIA), major bleeding, or death during follow-up.hard clinical

Complete cessation of antithrombotic therapy 6 months after LAAO in high bleeding risk patients is associated with a low incidence of subsequent stroke or TIA.

Authors

SWSiu‐Fung WongUnited Christian Hospital JMJames McCreadyUniversity Hospitals Sussex NHS Foundation Trust JCJames CockburnUniversity Hospitals Sussex NHS Foundation Trust

Discussion

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Implication

May support antithrombotic cessation 6 months post-LAAO in high-bleeding-risk AF; leaves open confirmation by RCTs.

Cite This Study

Wong et al. (2025) studied this question.

synapsesocial.com/papers/69f41cc8f3e494ed2b7d029d https://doi.org/10.1002/ccd.70014

Topics

Left atrial appendage closure Atrial fibrillation Persistent AF management Dual antiplatelet therapy

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Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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