# Antitrombotische therapie na LAA-occlusie: netwerk-meta-analyse

*geplaatst 2023-10-31 · Atriumfibrilleren · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2023.08.010 · https://hartvaat.nl/2023/10/31/antitrombotische-therapie-na-laa-occlusie-netwerk-meta-analyse/*

Netwerk-meta-analyse vergeleek antitrombotische regimes na LAA-occlusie. DAPT was het meest gebruikte regime maar DOAC monotherapie toonde vergelijkbare effectiviteit met potentieel minder bloedingen. Het optimale regime blijft onzeker.

## English: Network Meta-Analysis of Initial Antithrombotic Regimens After Left Atrial Appendage Occlusion.

This network meta-analysis compared antithrombotic regimens after LAA occlusion, showing that DOAC monotherapy may offer a better safety-efficacy profile than traditional DAPT for post-LAAO management.

## Abstract (original, from the publication)

BACKGROUND: The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with nonvalvular atrial fibrillation (AF) remains uncertain. OBJECTIVES: In this study, the authors sought to compare the efficacy and safety of various antithrombotic strategies after LAAO. METHODS: We searched the Medline, Cochrane, EMBASE, LILACS, and ClinicalTrials.gov databases for studies reporting outcomes after LAAO, stratified by antithrombotic therapy prescribed at postprocedural discharge. Direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random effects model network meta-analysis to estimate the OR and 95% CI for each comparison. P-scores provided a ranking of treatments. RESULTS: Forty-one studies comprising 12,451 patients with nonvalvular AF were included. DAPT, DOAC, DOAC plus SAPT, and VKA were significantly superior to no therapy to prevent device-related thrombosis. DOAC was associated with lower all-cause mortality than VKA (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). Compared with SAPT, DAPT was associated with fewer thromboembolic events (OR: 0.50; 95% CI: 0.29-0.88; P = 0.02), without a difference in major bleeding. In the analysis of P-scores, DOAC monotherapy was the strategy most likely to have lower thromboembolic events and major bleeding. CONCLUSIONS: In this network meta-analysis comparing initial antithrombotic therapies after LAAO, monotherapy with DOAC had the highest likelihood of lower thromboembolic events and major bleeding. DAPT was associated with a lower incidence of thromboembolic events compared with SAPT and may be a preferred option in patients unable to tolerate anticoagulation.

Auteurs: Pedro E P Carvalho, Douglas M Gewehr, Isabele A Miyawaki, Alleh Nogueira, Nicole Felix, Philippe Garot, Arthur Darmon, Patrizio Mazzone, Alberto Preda, Bruno R Nascimento, Luiz F Kubrusly, Rhanderson Cardoso

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2023.08.010. Bijgewerkt 2026-07-03T13:29:42Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.