Key result
Post-LAAC NOAC therapy is linked to lower mortality at ~8% alongside reduced DRT and bleeding.
Why the study?
The safety and efficacy of different antithrombotic strategies after left atrial appendage closure in high bleeding risk patients with nonvalvular atrial fibrillation were unclear.
Do NOACs improve clinical outcomes and reduce bleeding compared to antiplatelet therapy or warfarin in high bleeding risk patients after LAAC?
Cohort (n=893)
Do NOACs improve clinical outcomes and reduce bleeding compared to antiplatelet therapy or warfarin in high bleeding risk patients after LAAC?
p-value: p=0.011
In high bleeding risk patients who have undergone left atrial appendage closure, postoperative use of NOACs is associated with significantly lower rates of mortality, major bleeding, and MACE compared to antiplatelet therapies or warfarin.
May support NOAC preference post-LAAC in high-bleeding-risk patients; leaves open need for randomized confirmation.
BACKGROUND: In this study we aimed to evaluate the safety and efficacy of different antithrombotic strategy after left atrial appendage closure (LAAC) in high bleeding risk patients with nonvalvular atrial fibrillation. METHODS: In this study we included 893 patients with high bleeding risk who successfully underwent LAAC and categorized them into 4 groups on the basis of postprocedural antithrombotic regimen: single antiplatelet therapy (n = 27) or dual antiplatelet therapy (n = 143), warfarin (n = 97), and non-vitamin K antagonist oral anticoagulants (NOACs; n = 626). Kaplan-Meier survival curves and multivariate Cox regression were used. RESULTS: During a mean follow-up period of 46.17 months, the NOAC group exhibited superior outcomes: lower incidence of mortality (8.1% vs 10.5% for dual antiplatelet therapy, 18.6% for warfarin, and 14.8% for single antiplatelet therapy; P = 0.011), device-related thrombosis (DRT, 2.4% vs 7.0%, and 4.1%; P = 0.045), major bleeding (0.48% vs 2.1%, 2.0%, and 3.7%; P = 0.027) and major adverse cardiovascular events (5.9% vs 13.3%, 11.3%, and 7.4%; P = 0.012). Rivaroxaban showed greater efficacy in reducing mortality (6.9% vs 13.1%), DRT (1.6% vs 5.7%), and major adverse cardiovascular events (5.0% vs 9.8%), compared with dabigatran (all P < 0.05). The 15-mg dose showed a potential trend in reducing cardiac mortality and DRT (all P > 0.05). CONCLUSIONS: For high bleeding risk patients after LAAC, NOACs might provide a more favourable balance between thrombotic and bleeding risks, with less DRT and fewer ischemic strokes, without increasing mortality. Compared with the other doses, the 15-mg rivaroxaban group showed a potentially superior trend. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry: PID: 263473.
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Niu et al. (2026) conducted a cohort in Nonvalvular atrial fibrillation at high bleeding risk (n=893). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Single antiplatelet therapy, dual antiplatelet therapy, or warfarin was evaluated on Mortality (p=0.011). Post-LAAC NOAC therapy in high bleeding risk patients was associated with lower mortality (8.1% vs 10.5% DAPT, 18.6% warfarin, 14.8% SAPT; P=0.011), DRT, major bleeding, and MACE.
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