Single vs dual antiplatelet therapy after left atrial appendage closure: A propensity score matching analysis

BACKGROUND: Dual antiplatelet therapy and oral anticoagulation in combination with aspirin represent recommended treatment regimens after left atrial appendage closure (LAAC). As most patients receiving LAAC have high bleeding risk, less aggressive antithrombotic treatments are needed, such as single antiplatelet therapy. OBJECTIVE: We sought to compare both ischemic and bleeding outcomes in patients receiving single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) after successful LAAC. METHODS: Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2023 were prospectively collected including 1-year follow-up. Propensity score matching was performed for patients discharged under SAPT and DAPT. The primary end point was the 1-year composite of cardiovascular death, stroke, systemic embolism, or device-related thrombosis (DRT). The secondary end points included major bleeding and DRT. RESULTS: Of 1033 patients discharged with antiplatelet therapy, 154 patients receiving SAPT were compared with 230 matched patients receiving DAPT. The primary end point was similar between the study groups (SAPT 11.0% vs DAPT 8.3%; rate ratio, 1.14; 95% confidence interval CI, 0.83-1.55; P = .420). Consistently, we found no difference in terms of both major bleeding (SAPT 9.7% vs DAPT 12.6%; hazard ratio, 0.77; 95% CI, 0.43-1.39; P = .387) and DRT (2.6% vs 1.1%; rate ratio, 1.47; 95% CI, 0.89-2.43; P = .130) between the SAPT and DAPT groups. CONCLUSION: In this propensity score matching analysis of a single-center LAAC cohort, ischemic and bleeding outcomes did not differ at 1 year for patients discharged with SAPT or DAPT. These results have to be confirmed in an adequately powered randomized clinical trial.