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Meta-Analysis
. 2024 Aug;54(8):e14209.
doi: 10.1111/eci.14209. Epub 2024 Apr 10.

Single versus dual antiplatelet therapy following percutaneous left atrial appendage closure-A systematic review and meta-analysis

Saverio Continisio  1 , Carolina Montonati  2 , Filippo Angelini  3 , Pier Paolo Bocchino  3 , Carla Carbonaro  4 , Federico Giacobbe  4 , Veronica Dusi  3   4 , Ovidio De Filippo  3 , Alfonso Ielasi  2 , Giuseppe Giannino  4 , Emiliano Boldi  1 , Tommaso Fabris  5 , Fabrizio D'Ascenzo  3   4 , Gaetano Maria De Ferrari  3   4 , Giuseppe Tarantini  5
Affiliations
Meta-Analysis

Single versus dual antiplatelet therapy following percutaneous left atrial appendage closure-A systematic review and meta-analysis

Saverio Continisio et al. Eur J Clin Invest. 2024 Aug.

Abstract

Background: In the last few years, percutaneous LAA occlusion (LAAO) has become a plausible alternative in atrial fibrillation (AF) patients with contraindications to anticoagulation therapy. Nevertheless, the optimal antiplatelet strategy following percutaneous LAAO remains to be defined.

Methods: Studies comparing single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) following LAAO were systematically searched and screened. The outcomes of interest were ischemic stroke, device-related thrombus (DRT) and major bleeding. A random-effect meta-analysis was performed comparing outcomes in both groups. The moderator effect of baseline characteristics on outcomes was evaluated by univariate meta-regression analyses.

Results: Sixteen observational studies with 3255 patients treated with antiplatelet therapy (SAPT, n = 1033; DAPT, n = 2222) after LAAO were included. Mean age was 74.5 ± 8.3 years, mean CHA2DS2-VASc and HAS-BLED scores were 4.3 ± 1.5 and 3.2 ± 1.0, respectively. At a weighted mean follow-up of 12.7 months, the occurrence of stroke (RR 1.33; 95% CI 0.64-2.77; p =.44), DRT (RR 1.52; 95% CI 0.90-2.58; p =.12), and the composite of stroke and DRT (RR 1.26; 95% CI 0.67-2.37; p =.47) did not differ significantly between SAPT and DAPT groups. The rate of major bleedings was also not different between groups (RR 1.41; 95% CI 0.64-3.12; p =.39).

Conclusions: Among AF patients at high bleeding risk undergoing percutaneous LAAO, a post-procedural minimalistic antiplatelet strategy with SAPT did not significantly differ from DAPT regimens regarding the rate of stroke, DRT and major bleeding.

Keywords: antiplatelet therapy; atrial fibrillation; left atrial appendage occlusion.

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References

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