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June 19, 2023Circulation JournalOpen Access

Antithrombotic Regimen After Percutaneous Left Atrial Appendage Closure　― A Real-World Study ―

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Key result

Modified post-LAAC regimens without DAPT linked to 0% device-related thrombosis without increasing major bleeding.

  • P=0.0257
  • n=74

Why the study?

Antithrombotic therapy after left atrial appendage closure in patients at high risk of bleeding remains controversial.

Does a modified reduced-dose antithrombotic regimen after LAAC prevent device-related thrombosis and major bleeding compared to standard regimens in patients with high bleeding risk?

Population

74 consecutive patients receiving LAAC therapy

Comparison

Three post-LAAC antithrombotic regimens based on bleeding risk or clinical events

Design

Observational study

Authors

SRSatoko RyuzakiYKYusuke KondoMNMiyo Nakano

Discussion

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Overview

Modified regimens without DAPT may lower device thrombosis in high-bleeding-risk patients; leaves open confirmation by randomized trials before practice change.

Study Design

Type

Observational (n=74)

Multicenter

No

Structured PICO

Does a modified reduced-dose antithrombotic regimen after LAAC prevent device-related thrombosis and major bleeding compared to standard regimens in patients with high bleeding risk?

P
Population
74 consecutive patients with nonvalvular atrial fibrillation and high bleeding risk who underwent percutaneous left atrial appendage closure (LAAC) at a single center in Japan.
I
Intervention
Modified post-LAAC antithrombotic regimens: Regimen 2 (reduced antiplatelet drug doses without dual antiplatelet therapy, n=46) and Regimen 3 (antiplatelet drug administration for as long as possible for uncontrollable bleeding, n=11).
C
Comparator
Regimen 1 (Instruction For Use-listed standard regimen based on the SALUTE trial, n=16).
O
Outcome
Device-related thrombosis and major bleeding events.safety

Main Result

Absolute Event Rate: 0% vs 13%

p-value: p=0.0257

Limitations

  • Single-center observational study with a small sample size, which may have been statistically underpowered.
  • Low adherence rate to the follow-up imaging protocol for patients on regimen 3.
  • Single-center observational study
  • Small sample size
  • Statistically underpowered
  • Low adherence rate to follow-up imaging protocol for regimen 3

Cite This Study

Ryuzaki et al. (2023) conducted an observational in Nonvalvular atrial fibrillation with high bleeding risk (n=74). Modified antithrombotic regimens (Regimen 2 and 3) vs. Standard IFU-listed regimen (Regimen 1) was evaluated on Device-related thrombosis (p=0.0257). Modified post-LAAC antithrombotic regimens without dual antiplatelet therapy resulted in 0% device-related thrombosis compared to 13% with the standard regimen, with no difference in major bleeding.

synapsesocial.com/papers/6a1a29eb0fc4dc4e42436b61https://doi.org/10.1253/circj.cj-22-0687
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antithrombotic Therapy after Percutaneous Left Atrial Appendage Closure: Evidence, Challenges and Future Directions2023 · 17 citations
  2. 2Antithrombotic Therapy After Percutaneous Left Atrial Appendage Closure2026 · 1 citations
  3. 3Recurring Bleeding Events Requiring Red Blood Cell Transfusion After Left Atrial Appendage Closure Are Associated with Increased Mortality2026 · 1 citations
  4. 4Clinical practice in left atrial appendage closure with focus on antithrombotic therapy: results from a European Heart Rhythm Association survey2026
  5. 5Outcomes of percutaneous left atrial appendage closure in patients on single antiplatelet therapy versus other antithrombotic regimens2025