Short-term antiplatelet versus anticoagulant therapy after left atrial appendage closure: a systematic review and meta-analysis

AbstractThis meta-analysis compared the efficacy and safety of different antithrombotic regimens after left atrial appendage closure (LAAC).  PubMed, Embase, Medline, Cochrane Library databases were systematically searched from their inception to March 2023. Patients were divided into short-term oral anticoagulation (OAC) group and antiplatelet therapy (APT) group. The incidence of events were performed using RevMan 5.4. The events incl uding device-related thrombus (DRT), ischemic stroke/systemic embolization (SE), major bleeding, any bleeding, any major adverse event and all-cause mortality. Subgroup analysis were based on OAC alone or OAC plus single antiplatelet therapy (SAPT) in OAC group. Oral anticoagulants include warfarin and direct oral anticoagulant (DOAC). Fourteen studies with 35,166 patients were included. We found that the incidence of DRT (OR = 0.49, 95% CI 0.36–0.66,P ＜0.0001) and all-cause mortality (OR  = 0.71, 95% CI 0.57–0.89,P = 0.002) were significantly lower in OAC group than APT group. However, there was no statistical differences in the incidence rates of ischemic stroke/SE (OR = 0.77, 95% CI 0.49–1.20,P = 0.25), major bleeding (OR = 0.84, 95% CI 0.55–1.27,P = 0.84), any bleeding (OR = 0.83, 95% CI 0.56–1.22,P = 0.34) and any major adverse event (OR = 0.56, 95% CI 0.30–1.03,P = 0.06) in the two groups. Subgroup analysis found that the incidence of DRT, all-cause mortality and any major adver...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research