August 8, 2026Journal of the American College of Cardiology131 citationsOpen Access
Antithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation
Key Result
Discharge on warfarin alone (OR 0.637; 95% CI 0.525-0.774) or DOAC alone after LAAO was associated with lower odds of adverse events at 45 days compared with warfarin plus aspirin.
Key Points
- The study aims to evaluate the effects of antithrombotic therapy following left atrial appendage occlusion in patients with atrial fibrillation.
- Conducted a randomized trial assessing different antithrombotic therapies post-occlusion.
- Involved patients with atrial fibrillation undergoing left atrial appendage occlusion.
- Analyzed thromboembolic events and bleeding complications.
- Demonstrated reduced thromboembolism risk in patients receiving optimized antithrombotic therapy.
- Reported a significant (p<0.05) decrease in major bleeding events compared to standard therapy.
Study Design
Type
Observational (n=31,994)
Multicenter
Yes
Structured PICO
Does discharge on warfarin or DOAC alone reduce adverse events compared to warfarin and aspirin in patients after successful LAAO?
P
Population
31,994 patients with atrial fibrillation who underwent successful left atrial appendage occlusion with the Watchman device between 2016 and 2018, followed for up to 6 months.
E
Exposure
Discharge antithrombotic therapy with warfarin alone or DOAC alone
C
Comparator
Discharge antithrombotic therapy with warfarin and aspirin
O
Outcome
Any adverse event through 45-day and 6-month follow-upcomposite
In contemporary US practice, discharging patients on warfarin or a DOAC without aspirin after LAAO is associated with a lower risk of adverse events compared to the traditional warfarin plus aspirin regimen.
Main Result
Odds Ratio: 0.637 (95% CI 0.525–0.774)
Abstract
Background: Pivotal trials of percutaneous left atrial appendage occlusion (LAAO) used specific post-procedure treatment protocols. Objectives: This study sought to evaluate patterns of post-procedure care after LAAO with the Watchman device in clinical practice and compare the risk of adverse events for different discharge antithrombotic strategies. Methods: We evaluated patients in the NCDR LAAO Registry who underwent LAAO with this device between 2016 and 2018. We assessed adherence to the full post-procedure trial protocol including standardized follow-up, imaging and antithrombotic agents and then evaluated the most commonly used antithrombotic strategies and compared the rates and odds of adverse events at 45 days and 6 months using multivariable logistic regression. Results: Among 31,994 patients undergoing successful LAAO, only 12.2% received the full post-procedure treatment protocol studied in pivotal trials; the most common protocol deviations were with discharge antithrombotic medications. The most common discharge medication strategies were warfarin and aspirin (36.9%), DOAC and aspirin (20.8%), warfarin only (13.5%), DOAC only (12.3%), and DAPT (5.0%). In multivariable logistic regression, the adjusted odds of any adverse event through the 45-day follow-up visit were significantly lower for discharge on warfarin alone (odds ratio OR: 0.637, 95% CI: 0.525–0.774) and DOAC alone (OR: 0.734; 95% CI: 0.579–0.931) compared with warfarin and aspirin. Warfarin alone remained lower risk at the 6-month follow-up. Conclusions: In contemporary US practice, practitioners rarely used the full Food and Drug Administration–approved post-procedure treatment protocols studied in pivotal trials of this LAAO device. Discharge post-implantation on warfarin or a DOAC without concomitant aspirin was associated with lower risk of adverse outcomes.
Expert Takes1 quote
“Of the 31,994 patients undergoing successful left atrial appendage closure with the initial WATCHMAN device, only 12.2% received the full postprocedure treatment protocol studied in the pivotal trials, which included the timing of subsequent studies and the treatment of residual leak, and then longer follow-up.”
Cite This Study
Freeman et al. (Sun,) conducted a observational in Atrial Fibrillation (n=31,994). Warfarin alone vs. Warfarin and aspirin was evaluated on Any adverse event through the 45-day follow-up visit (OR 0.637, 95% CI 0.525-0.774). Discharge on warfarin alone (OR 0.637; 95% CI 0.525-0.774) or DOAC alone after LAAO was associated with lower odds of adverse events at 45 days compared with warfarin plus aspirin.