ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Thrombosis and Haemostasis
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1637290
This article is part of the Research TopicState of the Art in Antithrombotic TherapyView all 10 articles
Comparison of Oral Anticoagulation and Antiplatelet Therapy During Mid-Period After Percutaneous Left Atrial Appendage Closure
Provisionally accepted
Chang-Yi Li
Lu ZhouJing-Rui Zhang
Lihong HuangLi-Zhu Guo
Songnan Li*Cai-Hua Sang
Deyong Long
Jianzeng Dong- Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
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Background and aim There is a lack of evidence comparing anticoagulation and antiplatelet therapy during the mid-period time after Left atrial appendage closure (LAAC) in the real world (As the "early period" represent "45 days" after LAAC for a single procedure of LAAC and "3 months" after LAAC for a combined therapy of LAAC and catheter ablation, we defined the time after the "early period" to 6 months post LAAC as the "mid-period"). Our study aims to assess the safety and effectiveness of different anticoagulant therapy in patients receiving LAAC procedure with the WATCHMAN device during the mid-period after LAAC implantation in the real-world. Methods This prospective, single-center, cohort study included 374 consecutive patients undergoing percutaneous LAAC with the Watchman device. Patients were divided into two groups: oral anticoagulation (OAC) and antiplatelet therapy (APT) groups. The primary composite endpoint was cardiac mortality, ischemic stroke/ transient ischemic attacks (TIA) /systemic embolism, and major bleeding events after 6 months from the procedure. Secondary endpoints are cardiovascular death, device related thrombosis (DRT) events and each component of the primary endpoint. Results The risk of the primary outcome in the APT group and the OAC group had no statistical difference in multivariable Cox regression (adjusted HR=0.76; 95% CI: 0.40–1.49; P=0.447). All secondary endpoints, including cardiac mortality, cardiovascular death, ischemic stroke/systematic embolism, major bleeding events, and DRT events, did not statistically different between the two groups. 2 Conclusion During the mid-period time after LAAC implantation with the WATCHMAN device, OAC therapy may have similar safety and efficacy effect compared with dual antiplatelet therapy.
Keywords: Atrial Fibrillation, Left atrial appendage closure, anticoagulation, antiplatelet, Frail
Received: 29 May 2025; Accepted: 21 Oct 2025.
Copyright: © 2025 Li, Zhou, Zhang, Huang, Guo, Li, Sang, Long and Dong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Songnan Li, lisongnan@ccmu.edu.cn
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