{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:08:59Z","timestamp":1791461339201,"version":"4.3.4"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Reduced-dose direct oral anticoagulants (DOACs) are increasingly used after left atrial appendage closure (LAAC) in nonvalvular atrial fibrillation (NVAF), but their benefit over dual antiplatelet therapy (DAPT) remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the efficacy, safety, and net clinical benefit of reduced-dose DOAC versus DAPT following percutaneous LAAC in adults with NVAF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A systematic review and meta-analysis of randomized controlled trials and observational cohorts comparing reduced-dose DOAC (apixaban 2.5 mg twice daily or rivaroxaban 10-15 mg once daily) with DAPT after successful LAAC in adults (\u226518 years) with NVAF was conducted by searching PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov from inception through February 2026. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models; heterogeneity was assessed with\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 and \u03c7\u00b2 statistics. Analyses were performed with RevMan 5.4.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Seven studies (3 randomized controlled trials, 4 cohorts) including 2126 patients (reduced-dose DOAC = 1088; DAPT = 1038) were analyzed. Reduced-dose DOAC significantly reduced composite thromboembolic events (RR = 0.20, 95% CI = 0.10-0.39;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 0%), ischemic stroke (RR = 0.33, 95% CI = 0.13-0.80;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 0%), and device-related thrombosis (RR = 0.33, 95% CI = 0.18-0.60;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 0%) compared with DAPT. The net clinical benefit composite (thromboembolism plus major bleeding) favored reduced-dose DOAC (RR = 0.36, 95% CI = 0.19-0.70;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 63%), with apixaban-predominant subgroups showing strongest effects (RR = 0.14, 95% CI = 0.05-0.36). Major bleeding was lower (RR = 0.54, 95% CI = 0.35-0.83;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 0%), any bleeding reduced (RR = 0.52, 95% CI\n                      <jats:bold>=<\/jats:bold>\n                      0.30-0.88;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 64%), and minor bleeding trended lower (RR = 0.66, 95% CI = 0.42-1.02;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      \u00b2 = 34%), whereas cardiovascular (RR = 0.66, 95% CI = 0.23-1.92) and all-cause mortality (RR = 0.74, 95% CI = 0.42-1.30) did not differ significantly between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance:<\/jats:title>\n                    <jats:p>Reduced-dose DOAC therapy after LAAC lowered thromboembolic events, device-related thrombosis, and major bleeding versus DAPT, without affecting mortality. These findings support consideration of reduced-dose DOACs, especially apixaban-based regimens, in appropriately selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10600280261460464","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T07:04:55Z","timestamp":1783926295000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced Dose-Direct Oral Anticoagulant Vs Dual Antiplatelet Therapy After Left Atrial Appendage Closure in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Meta Analysis"],"prefix":"10.1177","author":[{"given":"Anurag","family":"Jha","sequence":"first","affiliation":[{"name":"King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4688-4057","authenticated-orcid":false,"given":"Nirmal","family":"Paudel","sequence":"additional","affiliation":[{"name":"Nishtar Medical University, Multan, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Azeem","family":"Malik","sequence":"additional","affiliation":[{"name":"King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Azam","sequence":"additional","affiliation":[{"name":"Shaikh Khalifa Bin Zayed Al Nahyan Medical &amp; Dental College, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arooba Ghafoor","family":"Butt","sequence":"additional","affiliation":[{"name":"Foundation University Medical College, Islamabad, 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Antithrombotic therapy after percutaneous left atrial appendage closure: evidence challenges and future directions. Rev Cardiovasc Med. 2023;24:343. 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