| Title: |
Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion:a network meta-analysis |
| Authors: |
Samaras, Athanasios; Karakasis, Paschalis; Feidakis, Athanasios; Giannakoulas, George; Fragakis, Nikolaos; Nielsen-Kudsk, Jens-Erik; Freixa, Xavier; Nair, Devi G; Freeman, James V; Bergmann, Martin; Landmesser, Ulf; Tzikas, Apostolos |
| Source: |
Samaras, A, Karakasis, P, Feidakis, A, Giannakoulas, G, Fragakis, N, Nielsen-Kudsk, J-E, Freixa, X, Nair, D G, Freeman, J V, Bergmann, M, Landmesser, U & Tzikas, A 2026, 'Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion : a network meta-analysis', European heart journal - Cardiovascular pharmacotherapy, vol. 12, no. 1, pp. 38-51. https://doi.org/10.1093/ehjcvp/pvaf078 |
| Publication Year: |
2026 |
| Collection: |
Aarhus University: Research |
| Subject Terms: |
Antithrombotic strategies; DOAC dosing; Direct oral anticoagulants; Left atrial appendage occlusion; Outcomes |
| Description: |
AIMS: The optimal short-term antithrombotic strategy following left atrial appendage occlusion (LAAO) remains uncertain, with the need to balance thromboembolic prevention and bleeding risk presenting a critical challenge. Recent evidence suggests that direct oral anticoagulants (DOACs) may provide a favourable safety-efficacy profile, with low-dose regimens showing potential benefits during the device endothelialization period. This network meta-analysis (NMA) aimed to compare the efficacy and safety of various antithrombotic strategies, including DOAC dosing, following LAAO. METHODS AND RESULTS: A systematic review and NMA were conducted following Cochrane and PRISMA guidelines. Eligible studies included randomized controlled trials (RCT) and observational studies comparing at least two antithrombotic regimens in patients with non-valvular atrial fibrillation undergoing percutaneous LAAO. Primary outcomes were major bleeding and thromboembolism. Secondary outcomes included device-related thrombosis (DRT) and all-cause mortality. Pairwise and network meta-analyses were performed using a random-effects model. A total of 52 studies (49 observational and 3 RCTs) involving 69 751 patients were included. DOACs were consistently associated with significantly lower rates of major bleeding and all-cause mortality than other antithrombotic regimens. Low-dose DOACs showed a potential advantage over standard-dose DOACs in reducing major bleeding risk (odds ratio 0.45, 95% confidence interval: 0.22-0.92). For thromboembolism and DRT, standard-dose DOAC significantly reduced risk compared with single antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT), whereas low-dose DOAC significantly reduced both outcomes compared with SAPT, DAPT, and vitamin K antagonists plus SAPT. In ranking analysis, DOACs emerged as the most effective and safest antithrombotic strategy, with low-dose DOACs demonstrating further safety benefits in bleeding outcomes. CONCLUSION: DOACs provide a superior safety-efficacy profile ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
2055-6837; 2055-6845 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41288078; info:eu-repo/semantics/altIdentifier/pissn/2055-6837; info:eu-repo/semantics/altIdentifier/eissn/2055-6845 |
| DOI: |
10.1093/ehjcvp/pvaf078 |
| Availability: |
https://pure.au.dk/portal/en/publications/5eeb38b6-1524-4b2a-8390-515d757ca9d4; https://doi.org/10.1093/ehjcvp/pvaf078; https://www.scopus.com/pages/publications/105029247586 |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.C896132C |
| Database: |
BASE |