Meta-Analysis Comparing Antiplatelet Therapy Versus Direct Oral Anticoagulation in Percutaneous Left Atrial Appendage Closure

Percutaneous left atrial appendage closure (LAAC) is currently an alternative treatment in patients with nonvalvular atrial fibrillation who are not candidates for long-term oral anticoagulation. 1 Al-Abcha A Saleh Y Elsayed M Elshafie A Herzallah K Baloch ZQ Banga S Rayamajhi S Abela GS. Left atrial appendage closure versus oral anticoagulation in non-valvular atrial fibrillation; a systematic review and meta-analysis. Cardiovasc Revasc Med. 2021; (S1553-8389(21)00207-4Epub ahead of printPMID: 33903038)https://doi.org/10.1016/j.carrev.2021.04.019 Crossref Scopus (3) Google Scholar The typical devices used are either a Watchman (Boston Scientific, Marlborough, MA), Amplatzer Cardiac Plug (St. Jude Medical, Minneapolis, MN), or Amplatzer Amulet (St. Jude Medical, Minneapolis, MN). The rate of device-related thrombus (DRT) has a reported onset of 30 to 90 days after the procedure. Therefore, medical management is warranted to decrease the risk and direct oral anticoagulation medications (DOACs) are typically used. 2 Asmarats L O'Hara G Champagne J Short-term oral anticoagulation versus antiplatelet therapy following transcatheter left atrial appendage closure. Circ Cardiovasc Interv. 2020; 13e009039https://doi.org/10.1161/CIRCINTERVENTIONS.120.003039 Crossref PubMed Scopus (0) Google Scholar The pathogenesis of DRT is linked to an endothelization process. Most patients who are candidates for LAAC placement have contraindications for DOAC therapy; thus, a single or double antiplatelet therapy (APT) may be more useful and well tolerated. 3 Liu XX Kleinecke C Busch S. Propensity-matched comparison of antiplatelet versus anticoagulation after left atrial appendage closure with the Watchman. Pacing Clin Electrophysiol. 2020; 43: 1242-1251https://doi.org/10.1111/pace.14032 Crossref PubMed Scopus (2) Google Scholar Hence, this meta-analysis was conducted in efforts to compare the safety and efficacy of APT versus DOACs in patients who have received percutaneous LAAC.