DOACs reduce device-related thrombosis and bleeding risk compared to DAPT after left atrial appendage closureDOACs Show Lower Risk of Blood Clots After Heart Procedure

Heart rhythm Published September 1, 2026 Study authors: Kaisaier Wulamiding, Xu Zixuan, Ye Min, Wu Zexuan, Dong Yugang, He Jiangui, Liu Chen, Chen Yili, Lip… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider DOACs as a favorable short-term antithrombotic option after left atrial appendage closure to reduce bleeding risk.

This meta-analysis evaluated the efficacy and safety of direct oral anticoagulants (DOACs) compared to dual antiplatelet therapy (DAPT) in 704 patients with atrial fibrillation undergoing percutaneous left atrial appendage closure. The analysis focused on primary outcomes of device-related thrombosis (DRT) and secondary outcomes including stroke, all-cause mortality, and bleeding events over a 2 to 3 month follow-up period.

The meta-analysis found that DOACs were associated with a significantly lower risk of device-related thrombosis (95% CI: 0.05-0.57). Additionally, patients receiving DOACs experienced significantly lower rates of major bleeding (95% CI: 0.26-0.81) and lower rates of minor bleeding (95% CI: 0.38-0.92) compared to those on DAPT. No statistically significant differences were observed between the two groups regarding stroke (95% CI: 0.07-3.13) or all-cause mortality (95% CI: 0.23-1.54).

Clinically, these results suggest that DOACs may serve as a favorable short-term antithrombotic option following left atrial appendage closure in selected patients. However, the short follow-up duration of 2 to 3 months limits the ability to generalize these findings to long-term outcomes. The evidence is based on a meta-analysis of randomized controlled trials, and the results should be interpreted with caution regarding long-term safety and efficacy.

How this fits prior evidence

This meta-analysis addresses a gap in managing patients after left atrial appendage closure. It specifically complements the finding that adding antiplatelet therapy to anticoagulation does not cut stroke risk but raises major bleeding. By showing that DOACs significantly reduce major bleeding (95% CI: 0.26-0.81) and device-related thrombosis (95% CI: 0.05-0.57) compared to DAPT, this evidence supports the use of DOACs as a preferred short-term option in this specific procedural context.

This analysis looked at 704 patients with atrial fibrillation who underwent a procedure called percutaneous left atrial appendage closure. Researchers compared the use of direct oral anticoagulants (DOACs) against dual antiplatelet therapy (DAPT) to see which treatment was more effective at preventing blood clots and bleeding.

The results showed that patients who took DOACs had a significantly lower risk of device-related thrombosis (blood clots near the medical device) compared to those on dual antiplatelet therapy. Additionally, the study found that DOACs were associated with a significantly lower risk of both major and minor bleeding events during the follow-up period.

While DOACs showed benefits for clot prevention and bleeding, there was no significant difference between the two treatments regarding stroke rates or overall mortality. Because this is a meta-analysis of clinical trials, it provides a useful look at how DOACs might work as a short-term option for certain patients. You should talk to your doctor to see if this treatment path is right for your specific heart condition.

What this means for you:

DOACs may lower the risk of blood clots and bleeding for some patients after a specific heart procedure.

Common questions

What are the benefits of using DOACs after this heart procedure?

Patients using DOACs showed a significantly lower risk of device-related thrombosis compared to those on dual antiplatelet therapy. The study also found that DOACs were associated with a significantly lower risk of both major and minor bleeding events during the follow-up period.

Are DOACs more effective at preventing strokes?

The study found no significant difference between DOACs and dual antiplatelet therapy regarding stroke rates. Similarly, there was no significant difference found between the two treatments for all-cause mortality.

Is it safe to use DOACs for this condition?

The study suggests DOACs are a favorable short-term option for some patients after this procedure. However, you should consult your doctor to determine the best treatment based on your personal health needs.

Study Details

Study typeMeta analysis

Sample sizen = 704

EvidenceLevel 1

Follow-up940.8 mo

PublishedSep 2026

PMID42002016

View Original Abstract ↓

BACKGROUND: Percutaneous left atrial appendage closure (LAAC) is an established alternative to oral anticoagulants for preventing thromboembolic events for selected patients with atrial fibrillation (AF). However, optimal post-procedural antithrombotic therapy remains uncertain, particularly regarding the use of direct oral anticoagulants (DOACs) vs dual antiplatelet therapy (DAPT). OBJECTIVE: This meta-analysis aimed to compare the efficacy and safety outcomes of DOACs vs DAPT in the early post-implant period following LAAC in patients with AF. METHODS: We systematically searched PubMed and Embase until November 2025 to identify randomized controlled trials (RCTs) that compared DOACs with DAPT after LAAC. Efficacy outcomes included device-related thrombosis (DRT), stroke, and all-cause mortality, whereas safety outcomes encompassed major and minor bleeding. Pooled effect estimates were calculated as odds ratios (ORs) with 95% confidence intervals (CIs). Where appropriate, fixed- or random-effects models were applied according to between-study heterogeneity. RESULTS: 3 RCTs (ADRIFT, ADALA, ANDES) involving 704 patients (mean age 75.8-78.4 years; 65% males) were included, with 368 assigned to DOAC and 336 to DAPT. Baseline thromboembolic and bleeding risk were high (mean CHADS-VASc 4.0-4.7; mean HAS-BLED 3.5-3.8). Clinical outcomes were evaluated at 2-3 months. Compared with DAPT, DOACs were associated with significantly lower risks of DRT (OR = 0.16; 95% CI: 0.05-0.57), major bleeding (OR = 0.46; 95% CI: 0.26-0.81) and minor bleeding (OR = 0.59; 95% CI: 0.38-0.92). No significant differences were observed in stroke (OR = 0.46; 95% CI: 0.07-3.13) and all-cause mortality (OR = 0.60; 95% CI: 0.23-1.54). CONCLUSION: In randomized trials of patients with AF undergoing LAAC, short-term DOAC-based regimens were associated with lower rates of DRT and fewer bleeding events than DAPT, without differences in stroke or mortality. These findings support DOACs as a favorable short-term antithrombotic option after LAAC in selected patients.

DOACs reduce device-related thrombosis and bleeding risk compared to DAPT after left atrial appendage closureDOACs Show Lower Risk of Blood Clots After Heart Procedure

How this fits prior evidence

Common questions

Study Details

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DOACs reduce device-related thrombosis and bleeding risk compared to DAPT after left atrial appendage closureDOACs Show Lower Risk of Blood Clots After Heart Procedure

How this fits prior evidence

Common questions

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Dual antiplatelet therapy reduces all-cause death but not MACE or myocardial infarction in MINOCA

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