{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:13:22Z","timestamp":1792761202326,"version":"4.5.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The optimal short-term antithrombotic strategy following left atrial appendage occlusion (LAAO) remains uncertain, with the need to balance thromboembolic prevention and bleeding risk presenting a critical challenge. Recent evidence suggests that direct oral anticoagulants (DOACs) may provide a favourable safety\u2013efficacy profile, with low-dose regimens showing potential benefits during the device endothelialization period. This network meta-analysis (NMA) aimed to compare the efficacy and safety of various antithrombotic strategies, including DOAC dosing, following LAAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A systematic review and NMA were conducted following Cochrane and PRISMA guidelines. Eligible studies included randomized controlled trials (RCT) and observational studies comparing at least two antithrombotic regimens in patients with non-valvular atrial fibrillation undergoing percutaneous LAAO. Primary outcomes were major bleeding and thromboembolism. Secondary outcomes included device-related thrombosis (DRT) and all-cause mortality. Pairwise and network meta-analyses were performed using a random-effects model. A total of 52 studies (49 observational and 3 RCTs) involving 69 751 patients were included. DOACs were consistently associated with significantly lower rates of major bleeding and all-cause mortality than other antithrombotic regimens. Low-dose DOACs showed a potential advantage over standard-dose DOACs in reducing major bleeding risk (odds ratio 0.45, 95% confidence interval: 0.22\u20130.92). For thromboembolism and DRT, standard-dose DOAC significantly reduced risk compared with single antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT), whereas low-dose DOAC significantly reduced both outcomes compared with SAPT, DAPT, and vitamin K antagonists plus SAPT. In ranking analysis, DOACs emerged as the most effective and safest antithrombotic strategy, with low-dose DOACs demonstrating further safety benefits in bleeding outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DOACs provide a superior safety\u2013efficacy profile compared with other antithrombotic strategies following LAAO, significantly reducing the risks of major bleeding, thromboembolic events, and mortality. While low-dose DOACs may offer additional bleeding risk reduction without compromising efficacy, further research is warranted to confirm their role in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaf078","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T12:59:59Z","timestamp":1763816399000},"page":"38-51","source":"Crossref","is-referenced-by-count":16,"title":["Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion: a network meta-analysis"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3404-2749","authenticated-orcid":false,"given":"Athanasios","family":"Samaras","sequence":"first","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki , 54124 Thessaloniki ,","place":["Greece"]},{"name":"Second Department of Cardiology, General Hospital \u2018Hippokration\u2019 , 54642 Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":false,"given":"Paschalis","family":"Karakasis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, General Hospital \u2018Hippokration\u2019 , 54642 Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Feidakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, University of Cologne , 50937 Cologne ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-6319","authenticated-orcid":false,"given":"George","family":"Giannakoulas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital of Thessaloniki , 54636 Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Fragakis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, General Hospital \u2018Hippokration\u2019 , 54642 Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Erik","family":"Nielsen-Kudsk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital , 8200 Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Freixa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institut Cardiovascular, IDIBAPS, Hospital Clinic of Barcelona , 08036 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devi G","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, St Bernard's Heart and Vascular Center , Jonesboro, AR 72401 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James V","family":"Freeman","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale University School of Medicine , New Haven, CT 06511 ,","place":["USA"]},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital , New Haven, CT 06511 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6140-7870","authenticated-orcid":false,"given":"Martin","family":"Bergmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Intensive Care Medicine, Asklepios Klinik Altona , 22763 Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Landmesser","sequence":"additional","affiliation":[{"name":"Charit\u00e9-University Medicine Berlin Corporate Member of Free University Berlin and Humboldt-University Berlin , 10117 Berlin, Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Berlin , 10785 Berlin, Germany"},{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Charit\u00e9, Campus Benjamin Franklin , 13353 Berlin, Germany"},{"name":"Berlin Institute of Health, Charit\u00e9-University Medicine Berlin , 13353 Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6968-2191","authenticated-orcid":false,"given":"Apostolos","family":"Tzikas","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki , 54124 Thessaloniki ,","place":["Greece"]},{"name":"Second Department of Cardiology, General Hospital \u2018Hippokration\u2019 , 54642 Thessaloniki ,","place":["Greece"]},{"name":"European Interbalkan Medical Center , 57001 Thessaloniki ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"2026020209254939700_pvaf078-B1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1093\/europace\/euz258","article-title":"EHRA\/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion\u2014an update","volume":"22","author":"Glikson","year":"2020","journal-title":"EP Europace"},{"key":"2026020209254939700_pvaf078-B2","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1161\/CIRCULATIONAHA.118.035090","article-title":"Device-related thrombus after left atrial appendage closure: incidence, predictors, and outcomes","volume":"138","author":"Dukkipati","year":"2018","journal-title":"Circulation"},{"key":"2026020209254939700_pvaf078-B3","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1016\/j.jacc.2015.04.025","article-title":"Left atrial appendage closure as an alternative to 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