Safety review of antithrombotic therapy options after left atrial appendage occlusion

Left atrial appendage occlusion (LAAO) is a viable alternative to anticoagulation for treatment in patients with non-valvular atrial fibrillation (NVAF) who cannot tolerate anticoagulation. Post-procedure patients are generally prescribed oral anticoagulation (OAC) for 45 days, while the device is undergoing endothelialization, following which patients are continued on antiplatelet agents. Recommendations for antithrombotic agents following LAAO arrived by consensus, which are not tolerated by all patients. This review covers the safety profile of antithrombotic therapy options after LAAO. We discuss the side effect profiles including device-related thrombosis (DRT), bleeding, and thromboembolic events. The new randomized controlled trials and meta-analysis compared combinations of DOAC with single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), VKA, or only SAPT and studied the incidence of major bleeding, DRT, and thromboembolic events. This review is a comprehensive summary of different antithrombotic agents' combinations along with the duration recommendations and emphasizes the importance of a discussion among involved team members and patients. In patients with NVAF undergoing LAAO, initial post-procedural antithrombotic monotherapy with DOAC is associated with low rates of thromboembolism, DRT, and major bleeding followed by DAPT. DAPT is associated with lower incidence of thromboembolic events in comparison to SAPT.