Left atrial appendage occlusion procedure and antithrombotics: less may be enough for lower risk patients: A single-center observational study

Antithrombotic therapy following left atrial appendage occlusion (LAAO) is recommended to prevent device-induced thrombosis and stroke. Guidelines suggest oral anticoagulants and aspirin for the first 45 days and then dual antiplatelet therapy for 6 months. However, regimens for antithrombotic therapy varies widely. This study aimed to assess the characteristics of patients receiving minimal versus standard antithrombotic therapy post-LAAO, and to examine the association between treatment type and thrombotic/bleeding risk scores. We conducted a retrospective observational study of patients who underwent LAAO at a teaching hospital between April and December 2023. Patients were categorized into minimal (DOAC only) or standard (DOAC plus aspirin) therapy groups during the first 45 days, and into minimal (SAPT) or standard (DAPT) groups from 45 days to 6 months. Outcomes included CHA2DS2-VASc and HAS-BLED scores, comorbidities, and bleeding/thrombotic events. Statistical analyses included univariate and bivariate comparisons using Chi-square, Fisher exact test, and t-tests. Among 33 patients, 82% received minimal therapy and 18% for the standard therapy in the first 45 days. Standard therapy patients had higher rates of transient ischemic attack (50% vs 7.5%), stroke (100% vs 37%), coronary artery disease (100% vs 44.4%), and NSAID use (33.3% vs 3.7%, P < .05). The CHA2DS2-VASc scores were significantly higher in the standard group (6.5 ± 0.5 vs 4.6 ± 1.4, P = .002), with no difference in HAS-BLED scores. From 45 days to 6 months, 15.2% received minimal and 84.8% for the standard therapy, with no significant differences in scores. Patients with lower CHA2DS2-VASc scores were more likely to receive minimal therapy, indicating potential for risk-guided antithrombotic management post-LAAO. Further studies are needed to validate individualized treatment strategies.