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TOPLINE
In a meta-analysis of three trials, patients who received monotherapy with direct oral anticoagulants (DOACs; also known as non-vitamin K antagonist oral anticoagulants) after left atrial appendage occlusion had a lower risk for device-related thrombosis and major bleeding than those who received dual antiplatelet therapy (DAPT).
METHODOLOGY
- Researchers conducted a meta-analysis of randomized trials to compare the safety and efficacy of monotherapy with DOACs and DAPT after left atrial appendage occlusion.
- They searched four major databases through May 2026 and included three randomized trials conducted at multiple centers in Europe and Canada.
- The analysis involved 704 patients (mean age, approximately 76-78 years; 65% men). The patients had substantial risks for stroke and bleeding.
- Two trials used reduced doses of DOACs (10 mg or 15 mg rivaroxaban once daily and 2.5 mg apixaban twice daily), and one trial used standard doses of any of four DOACs used for atrial fibrillation. The treatment lasted 2-3 months.
- The primary endpoint was device-related thrombosis. The additional outcomes assessed included major and minor bleeding, stroke/systemic embolism, and all-cause and cardiovascular mortality.
TAKEAWAY
- Monotherapy with DOACs was associated with an 83% lower risk for device-related thrombosis than DAPT (P = .022; heterogeneity [I2] = 0%).
- Monotherapy with DOACs was associated with a 49% lower risk for major bleeding than DAPT (P = .045; I2 = 0%). The risk for minor bleeding did not differ significantly between the two treatment regimens (I2 = 22%).
- All-cause and cardiovascular mortality and stroke/systemic embolism were uncommon, and their occurrence after monotherapy with DOACs and after DAPT did not differ significantly.
IN PRACTICE
"[The] findings suggest that a strategy focused on thrombotic protection with DOAC monotherapy does not appear to incur a bleeding penalty compared with DAPT," the researchers wrote.
SOURCE
The study was led by Ahmed Samy Badran of Ain Shams University in Cairo, Egypt, and Gregg W. Stone of Mount Sinai Fuster Heart Hospital, New York City. It was published online on October 13 as rapid communication in the European Heart Journal.
LIMITATIONS
The analysis covered only three trials, and the combined number of patients was modest. The trials differed in the regimens of DOACs, devices, and the duration of follow-up. Researchers used aggregate data from each trial rather than individual patient data.
DISCLOSURES
The study did not receive any funding. One author reported receiving consulting fees from many medical device companies and holding equity or stock options in several others; the employer of the author also received research grants from several device companies. The other author did not report any disclosures.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
