Discharge on DOAC alone after left atrial appendage occlusion was associated with a lower rate of major adverse events at 45 days compared with DOAC plus aspirin (HR 0.78; 95% CI 0.68-0.91).
Cohort (n=53,878)
Yes
Does DOAC alone or warfarin alone reduce major adverse events and major bleeding compared with DOAC plus aspirin in patients following successful LAAO?
In real-world practice, discharging patients on DOAC alone after LAAO is associated with significantly lower rates of major adverse events and major bleeding compared to DOAC plus aspirin, without increasing stroke or device-related thrombus risk.
Hazard Ratio: 0.78 (95% CI 0.68–0.91)
BACKGROUND The prevalence of and outcomes associated with different antithrombotic strategies after left atrial appendage occlusion (LAAO) are not well described. OBJECTIVES This study sought to evaluate patterns of antithrombotic medication strategies at discharge following LAAO with the Watchman FLX device in real-world practice and to compare the risk of adverse events among the different antithrombotic regimens. METHODS The authors evaluated patients in the NCDR (National Cardiovascular Data Registry) LAAO Registry who underwent LAAO with the second-generation LAA closure device between 2020 and 2022. They grouped patients by mutually exclusive discharge antithrombotic strategies and compared the rates of adverse events at 45 days and 6 months using multivariable Cox proportional hazards regression. RESULTS Among 53,878 patients undergoing successful LAAO with the second-generation LAA closure device, the most common antithrombotic discharge regimens were direct oral anticoagulant (DOAC) plus aspirin (48.3%), DOAC alone (22.6%), dual antiplatelet therapy (8.1%), warfarin plus aspirin (7.7%), and DOAC plus P2Y12 inhibitor (4.9%). In multivariate analysis, DOAC alone had a lower rate of major adverse events and major bleeding at 45 days of follow-up compared with DOAC plus aspirin (major adverse events: HR: 0.78; 95% CI: 0.68-0.91; major bleeding: HR: 0.69; 95% CI: 0.60-0.80). These differences persisted at 6 months. Warfarin without aspirin also showed lower rates of major bleeding at both time points. No differences were seen in stroke/transient ischemic attack or device-related thrombus. CONCLUSIONS In real-world U.S. practice, discharge on DOAC alone or warfarin alone was associated with a lower rate of adverse events compared with DOAC plus aspirin.
“The aspirin really doesn't add anything in terms of preventing thrombotic events and it substantially increases the risk for bleeding. So that's really our main take-home here, and the thing we care about most is trying to get practice to move away from adding aspirin to DOAC in the postprocedural period.”
Reinhardt et al. (Mon,) conducted a cohort in Left atrial appendage occlusion (n=53,878). DOAC alone vs. DOAC plus aspirin was evaluated on Major adverse events at 45 days (HR 0.78, 95% CI 0.68-0.91). Discharge on DOAC alone after left atrial appendage occlusion was associated with a lower rate of major adverse events at 45 days compared with DOAC plus aspirin (HR 0.78; 95% CI 0.68-0.91).
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