Navigating the complexities of antithrombotic therapy after LAAO

Left atrial appendage occlusion (LAAO) is a promising stroke prevention strategy for atrial fibrillation patients who are intolerant to oral anticoagulants (OAC)1. Although the premise of LAAO is to replace OAC, a brief course of antithrombotic therapy is recommended post-procedure to mitigate the risk of device-related thrombus (DRT). However, the optimal duration and regimen of antithrombotic therapy remain unclear, leading to diverse practices and continuous debate. Indeed, studies supporting specific antithrombotic regimens after LAAO included heteroÂgeneous populations treated with various devices, and these yielded conflicting results23.

In this issue of EuroIntervention, Kramer et al sought to assess the long-term outcomes of an appealing but infrequently utilised antithrombotic strategy after LAAO: single antiplatelet therapy (SAPT)4. Their study included 553 patients who underwent LAAO using an Amplatzer device (Abbott) between 2010 and 2021, of whom 78% were prescribed SAPT post-LAAO. The primary endpoint was the presence of DRT on imaging at 6 to 12 weeks. Other outcomes included mortality, stroke, and major bleeding (Bleeding Academic Research Consortium Type ≥2). Short-term data were obtained from a well-maintained institutional registry,...