Key result
Early antithrombotic discontinuation after LAAC is not associated with increased stroke risk.
Why the study?
Optimal postprocedural antithrombotic management after left atrial appendage closure remains undefined, especially in patients with high bleeding risk, and evidence supporting early complete cessation is limited.
Does early complete discontinuation of antithrombotic therapy (<6 months) prevent stroke events in high-bleeding-risk patients following left atrial appendage closure?
Meta-Analysis (n=1,841)
Does early complete discontinuation of antithrombotic therapy (<6 months) prevent stroke events in high-bleeding-risk patients following left atrial appendage closure?
In patients at high bleeding risk undergoing LAAC, early complete discontinuation of antithrombotic therapy (<6 months) appears safe with no significant increase in thromboembolic events or mortality compared to longer treatment.
May support shorter antithrombotic regimens after LAA closure; leaves open need for RCT confirmation.
OBJECTIVES: Optimal postprocedural antithrombotic management after left atrial appendage closure (LAAC) remains undefined, particularly in patients with high bleeding risk. Early complete cessation (<6 months) of antithrombotic therapy (AT) following LAAC is increasingly adopted, yet supportive evidence is limited. This study sought to evaluate the safety of early (<6 months) complete discontinuation of AT after LAAC. METHODS: A systematic review and meta-analysis of observational studies was conducted. PubMed and Scopus were searched through September 2025. The primary endpoint was stroke events; secondary endpoints included all-cause mortality, major bleeding, and device-related thrombus (DRT). Random-effects models were used to calculate pooled risk ratios (RRs). Subgroup and sensitivity analyses were performed. RESULTS: Seven studies including 1841 patients (529 with early AT cessation) were analyzed. Patients undergoing early AT discontinuation exhibited high baseline thromboembolic and bleeding risk, and most of them (67%) had prior bleeding events. Over a weighted mean follow-up of 19.2 months, early discontinuation of AT was not associated with increased risk of stroke (RR, 1.04; 95% CI, 0.40-2.66), all-cause death (RR, 1.03; 95% CI, 0.49-2.17), major bleeding (RR, 1.22; 95% CI, 0.75-2.01), or DRT (RR, 0.49; 95% CI, 0.14-1.73). No significant differences were observed between very early (<1 month) and early (<6 months) cessation strategies. CONCLUSIONS: Among high-bleeding-risk patients undergoing LAAC, early complete discontinuation of AT was not associated with an increased risk of thromboembolic events or death during mid-term follow-up. These results support the potential ischemic safety of early antithrombotic cessation in carefully selected patients and highlight the need for definite evidence from randomized trials.
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Vidal-Calés et al. (2026) conducted a meta-analysis in High bleeding risk following left atrial appendage closure (n=1,841). Early (<6 months) complete discontinuation of antithrombotic therapy vs. Later or no discontinuation of antithrombotic therapy was evaluated on Stroke events (RR 1.04, 95% CI 0.40-2.66). Early discontinuation of antithrombotic therapy (<6 months) after left atrial appendage closure was not associated with increased risk of stroke compared to later cessation (RR 1.04; 95% CI 0.40-2.66).
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