Abstract A131: Stroke Prevention and Bleeding Risk with Direct Oral Anti-Coagulants (DOACs) as Compared to Dual Anti-Platelet Therapy (DAPT) after Left Atrial Appendage Closure in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Introduction: Atrial Fibrillation is one of the leading causes of ischemic stroke globally. Left Atrial Appendage Occlusion (LAAO) serves as a standard alternative to long-term anti-coagulation in atrial fibrillation patients who are at increased bleeding risk or unable to tolerate antithrombotic therapy. However, they remain at risk of thrombotic complications and ischemic stroke. At present, there are no strict guidelines regarding the optimal short-term therapy after LAAO in patients with atrial fibrillation. Objective: To compare the efficacy of DOAC for stroke prevention and device-related thrombus after LAAO in atrial fibrillation as compared to DAPT therapy. Methods: We performed a thorough literature search of databases including PubMed, Embase, and Cochrane from inception till 31st July 2025. Eligible studies included patients on DOACs versus DAPT LAAO. Primary outcomes included device-related thrombus, Ischemic Stroke or TIA, major bleeding, and all-cause mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Analysis was performed in Comprehensive Meta-Analysis (CMA) software. Results: A total of 9 studies (RCTs and observational studies) were included in this meta-analysis, enrolling 17,167 patients receiving DOAC and 6,574 patients receiving DAPT. The mean CHA2DS2-VASc score was similar across groups (4.2 in DOAC vs 4.3 in DAPT). Atrial or Device-related thrombus was reported in 9 studies; DOAC was associated with a significantly lower risk compared with DAPT (OR 0.35, 95% CI 0.19–0.1.64; p = 0.001). Ischemic Stroke or TIA was reported in 5 studies, and no significant difference was observed (OR 0.794, 95% CI 0.48–1.129; p = 0.118). Major bleeding was reported in 6 studies, and we found that DOAC use was associated with a significantly lower risk compared with DAPT (OR 0.52, 95% CI 0.39–0.69; p < 0.001). Mortality was reported in 4 studies; no significant difference was observed (OR 1.05, 95% CI 0.45–2.43; p = 0.916). Conclusion: In patients undergoing LAAO, DOAC therapy was associated with lower risks of device-related thrombus and major bleeding compared with DAPT, without significant differences in the risk of stroke/TIA or mortality. These findings suggest DOACs can provide a safer antithrombotic strategy following LAAO. However, further randomized controlled studies are required to determine the ideal therapy and doses.