Outcomes of percutaneous left atrial appendage closure in patients on single antiplatelet therapy versus other antithrombotic regimens

Abstract Background Percutaneous left atrial appendage (LAA) closure is a well-established strategy for stroke prevention in patients with non-valvular atrial fibrillation who have contraindications to long- term oral anticoagulation (OAC). However, the optimal post-procedural antithrombotic regimen remains controversial. Objective To review cardiovascular events including embolic and hemorrhagic events during the follow-up of patients who underwent LAA closure depending on the antithrombotic regimen. Methods We retrospectively analyzed 140 patients who underwent LAA closure at a single center between July 2016 and January 2025. The mean age was 76.4 years (range: 47.1–92.9). Indications for LAA closure included gastrointestinal bleeding (35%), recurrent ischemic stroke (25.71%), intracranial hemorrhage (21.43%), and other bleeding events (17.86%). Post-procedural antithrombotic regimens included dual antiplatelet therapy (DAPT) in 59 patients, single antiplatelet therapy (SAPT) in 37 patients, OAC in 19 patients, and combined OAC and antiplatelet therapy in 17 patients. Devices used were predominantly Amulet (120 patients), followed by Lambre (12 patients) and Watchman (3 patients). Mean follow-up was of 24.3 ± 14.7 months. Results The incidence of embolic events in the SAPT group was not higher compared to other regimens (χ² 25.34; p-value: 0.133). Hemorrhagic events were significantly lower in SAPT patients (χ²: 31.82; p value: 0.0015). Mortality rates increased over time: 7.86% at 1 year, 11.43% at 2 years, and 24.29% at 5 years. Conclusions Our findings highlight that patients on SAPT after LAA closure do not experience more embolic events compared to other antithrombotic strategies, while having a significantly lower risk of hemorrhagic events. These results emphasize the need for individualized post- procedural management to optimize safety and efficacy.