The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Efficacy and Safety of Dual Antiplatelet 
Therapy Versus Direct Oral Anticoagulant 
Following Left Atrial Appendage Closure:  
A Systematic Review and Meta-Analysis 
N. Patel, MD1*, M. Patel1, MD, C. Burmeister, MD1, S. Bhuta, MD1, A. Elzanaty,
MD2, E. Eltahawy3, MD 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Department of Urology, The University of Toledo, Toledo, OH 43614 
3Division of Cardiovascular Medicine, Department of Medicine, The University of 
Toledo, Toledo, OH 43614 

*Corresponding author: neha.patel@utoledo.edu

Published: 05 May 2023 

Background: Percutaneous left atrial appendage occlusion (LAAO) offers a nonpharmacologic strategy 
for stroke prevention in patients with atrial fibrillation, however it carries the risk of device thrombosis. 
Current guidelines recommend oral anticoagulant for 45 days, followed by dual antiplatelet therapy 
(DAPT) for 6 months. However, given the high bleeding risk in this population, studies have been done 
comparing DAPT to direct oral anticoagulants (DOAC) following LAAO.   

Methods: We performed a literature search using PubMed, Embase, and Cochrane Library from 
inception through February 2022 to investigate the efficacy and safety of DAPT compared to DOAC in 
patients following LAAO. The primary outcome was all-cause mortality and secondary outcomes were 
ischemic stroke, device related thrombosis, and major bleeding.    

Results: A total of three studies including 400 patients (150 patients received DOAC and 250 received 
DAPT) were included. All-cause mortality was significantly higher in the DAPT group compared to the 
DOAC group (RR 2.29, 95% CI 1.31-4.01, P=0.004). The rates of DRT (RR 4.82, 95% CI 0.60-38.89, 
P=0.14), ischemic stroke (RR 1.23, 95% CI 0.38-4.05, P=0.73), and major bleeding (RR 1.34, 95% CI 
0.50-3.65, P=0.56) were numerically lower in the DOAC group compared to DAPT group, although the 
differences did not reach statistical significance.   

Conclusion: Our study demonstrated the superiority of DOACs vs. DAPT following LAAO in terms of 
all-cause mortality. DOACs had lower DRT, ischemic stroke, and major bleeding trends compared to 

https://dx.doi.org/10.46570/utjms.vol11-2023-712 

https://dx.doi.org/10.46570/utjms.vol11-2023-712
mailto:neha.patel@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-712   UTJMS 11(1):e1-e2    

https://dx.doi.org/10.46570/utjms.vol11-2023-712  2 ©2023 UTJMS  
 

  
 

DAPTs but the differences were not statistically significant. Large-scale trials comparing DOAC and 
DAPT are necessary to validate our findings. 

https://dx.doi.org/10.46570/utjms.vol11-2023-712
https://dx.doi.org/10.46570/utjms.vol11-2023-712