The Journal of invasive cardiology · 2026
Early discontinuation of antithrombotic therapy following left atrial appendage closure: a systematic review and meta-analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Vidal-Calés Pablo, Battistolo Quentin, Ruel Maxim, Prieto-Lobato Alicia, Cepas-Guillen Pedro, Freixa Xavier, Rodés-Cabau Josep
Аннотация
OBJECTIVES: Optimal postprocedural antithrombotic management after left atrial appendage closure (LAAC) remains undefined, particularly in patients with high bleeding risk. Early complete cessation (<6 months) of antithrombotic therapy (AT) following LAAC is increasingly adopted, yet supportive evidence is limited. This study sought to evaluate the safety of early (<6 months) complete discontinuation of AT after LAAC.
METHODS: A systematic review and meta-analysis of observational studies was conducted. PubMed and Scopus were searched through September 2025. The primary endpoint was stroke events; secondary endpoints included all-cause mortality, major bleeding, and device-related thrombus (DRT). Random-effects models were used to calculate pooled risk ratios (RRs). Subgroup and sensitivity analyses were performed.
RESULTS: Seven studies including 1841 patients (529 with early AT cessation) were analyzed. Patients undergoing early AT discontinuation exhibited high baseline thromboembolic and bleeding risk, and most of them (67%) had prior bleeding events. Over a weighted mean follow-up of 19.2 months, early discontinuation of AT was not associated with increased risk of stroke (RR, 1.04; 95% CI, 0.40-2.66), all-cause death (RR, 1.03; 95% CI, 0.49-2.17), major bleeding (RR, 1.22; 95% CI, 0.75-2.01), or DRT (RR, 0.49; 95% CI, 0.14-1.73). No significant differences were observed between very early (<1 month) and early (<6 months) cessation strategies.
CONCLUSIONS: Among high-bleeding-risk patients undergoing LAAC, early complete discontinuation of AT was not associated with an increased risk of thromboembolic events or death during mid-term follow-up. These results support the potential ischemic safety of early antithrombotic cessation in carefully selected patients and highlight the need for definite evidence from randomized trials.
METHODS: A systematic review and meta-analysis of observational studies was conducted. PubMed and Scopus were searched through September 2025. The primary endpoint was stroke events; secondary endpoints included all-cause mortality, major bleeding, and device-related thrombus (DRT). Random-effects models were used to calculate pooled risk ratios (RRs). Subgroup and sensitivity analyses were performed.
RESULTS: Seven studies including 1841 patients (529 with early AT cessation) were analyzed. Patients undergoing early AT discontinuation exhibited high baseline thromboembolic and bleeding risk, and most of them (67%) had prior bleeding events. Over a weighted mean follow-up of 19.2 months, early discontinuation of AT was not associated with increased risk of stroke (RR, 1.04; 95% CI, 0.40-2.66), all-cause death (RR, 1.03; 95% CI, 0.49-2.17), major bleeding (RR, 1.22; 95% CI, 0.75-2.01), or DRT (RR, 0.49; 95% CI, 0.14-1.73). No significant differences were observed between very early (<1 month) and early (<6 months) cessation strategies.
CONCLUSIONS: Among high-bleeding-risk patients undergoing LAAC, early complete discontinuation of AT was not associated with an increased risk of thromboembolic events or death during mid-term follow-up. These results support the potential ischemic safety of early antithrombotic cessation in carefully selected patients and highlight the need for definite evidence from randomized trials.