ArticleHeart rhythm2026
Patterns of antithrombotic treatment after left atrial appendage occlusion.
Article in Heart rhythm, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeft atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF); however, data on post-LAAO antithrombotic patterns remain limited.
objectiveThis study aimed to characterize post-LAAO antithrombotic patterns in routine clinical practice.
methodsPatients with AF aged ≥65 years undergoing first-time LAAO were included from Optum claims data (2015-2024). OAC discontinuation was defined as an absence of refill in 60 days. Prolonged OAC use was operationally defined as an OAC refill after an imaging evaluation performed 30-90 days after implantation or an OAC refill beyond 90 days after implantation.
resultsAmong 16,304 LAAO recipients (mean age 78; 47% female), 9844 (60%) received an OAC and 3499 (10%) received a P2Y12 inhibitor (either alone or with an OAC) after implantation. At 6 months after the procedure, 6.5% of patients remained on OAC and 39% remained on P2Y12 inhibitors. Among OAC users, the median duration of use was 54 days and 83% discontinued by 6 months. Among OAC users with an imaging assessment by 45 days (n = 6856), 39% of patients followed the recommended treatment protocol; common deviations included early OAC discontinuation (31%) and continued OAC use beyond 6 months (11%). Prolonged OAC use was observed in 2030 patients (12.5%). Factors associated with prolonged OAC use included black race, kidney disease, AF ablation, cardioversion, and longer pre-LAAO OAC use.
conclusionWe observed heterogeneous patterns of post-LAAO antithrombotic therapy, with a substantial proportion of patients remaining on OAC or P2Y12 inhibitors beyond suggested durations, indicating an opportunity to improve practice and outcomes.
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