Percutaneous left atrial appendage occlusion (LAAO) is an established alternative to chronic anticoagulation in patients with non-valvular atrial fibrillation (AFib). A clinically relevant complication of the procedure is device-related thrombosis (DRT). Pharmacological management around implantation remains subject to debate, with no optimal postprocedural antithrombotic strategy yet defined.
The multicenter, randomized ANDES trial compared anticoagulation with direct oral anticoagulation (DOAC) versus dual antiplatelet therapy (DAPT) during the first 60 days after LAAO.
A total of 510 patients were treated at 13 centers in Canada and Europe. In the DOAC group, the most commonly used drugs were rivaroxaban (46%), apixaban (32%), dabigatran (15%), and edoxaban (7%).
The primary endpoint was the incidence of DRT at 60 days, assessed by transesophageal echocardiography (TEE) with centralized analysis. The incidence was similar between groups in the per-protocol analysis: 3.3% with DOAC vs. 4.7% with DAPT (p=0.48), not statistically significant.
In the safety analysis, the rate of major bleeding (BARC ≥3) was 1.2% in the DOAC group vs. 3.9% in the DAPT group, while clinically relevant bleeding occurred in 4.5% and 8.0%, respectively. There were no differences in mortality, stroke, or ischemic events.
Conclusion
The ANDES study showed that DOACs do not significantly reduce the incidence of DRT compared with DAPT in the short term after LAAO. However, they demonstrated a better bleeding safety profile, supporting their use as a safer strategy in this context.
Presented by Josep Rodés-Cabau at TCT 2025 Late-Breaking Clinical Trials, October 26, San Francisco, USA.
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