Left Atrial Appendage Closure With Different Antithrombotic Therapies in Patients at High Bleeding Risk: A Ten-Year Cohort Study.
BACKGROUND This study aimed to evaluate the safety and efficacy of different antithrombotic strategy following left atrial appendage closure (LAAC) in high bleeding risk patients with non-valvular atrial fibrillation. METHODS This study included 893 patients with high bleeding risk who successfully underwent LAAC and categorized them into four groups based on post-procedural antithrombotic regimen: single or dual antiplatelet therapy (SAPT, n = 27; DAPT, n = 143), warfarin (n = 97) and non-vitamin K antagonist oral anticoagulant (NOAC, n = 626). Kaplan-Meier survival curves and multivariate Cox regression were used. RESULTS During a mean follow-up period of 46.17 months, NOAC group exhibited superior outcomes: lower incidence of mortality (8.1% vs. 10.5% for DAPT, 18.6% for warfarin and 14.8% for SAPT, p = 0.011), device-related thrombosis (DRT, 2.4% vs. 7.0% and 4.1%, p = 0.045), major bleeding (0.48% vs. 2.1%, 2.0% and 3.7%, p = 0.027) and major adverse cardiovascular event (MACE, 5.9% vs. 13.3%, 11.3% and 7.4%, p = 0.012). Rivaroxaban demonstrated greater efficacy in reducing mortality (6.9% vs. 13.1%), DRT (1.6% vs. 5.7%) and MACE (5.0% vs. 9.8%), compared to dabigatran (all p < 0.05). The 15mg dose demonstrated potential trend in reducing cardiac mortality and DRT (all p > 0.05). CONCLUSIONS For high bleeding risk patients after LAAC, NOACs may provide a more favorable balance between thrombotic and bleeding risks, with lower DRT and fewer ischemic strokes, without increasing mortality. Compared to the other doses, the 15-mg rivaroxaban group demonstrated a potentially superior trend.