In patients with non-valvular atrial fibrillation undergoing LAAC, DOACs offered a safer short-term alternative to DAPT. This multicenter international randomized trial, published in Circulation, compared DOACs with DAPT (aspirin plus clopidogrel) for 60 days after LAAC to assess device-related thrombosis and safety outcomes.

The trial included 510 patients (mean age 77 years, 35% women) randomly assigned to DOAC or DAPT. At 60 days, transesophageal echocardiography was performed in 399 patients who remained on the assigned regimen. Device-related thrombosis occurred in 1.5% of the DOAC group and 4.1% of the DAPT group, a difference that did not reach statistical significance.

The composite safety endpoint, which included all-cause mortality, stroke, bleeding, or thrombosis requiring treatment change, favored DOACs (22.5% vs. 34.9%, p = 0.003). The safety advantage was mainly due to fewer bleeding events (17.4% vs. 24.9%, p = 0.038). Although DOACs did not significantly reduce thrombosis risk, their improved safety profile supports their potential as a preferred short-term antithrombotic option following LAAC. Larger trials are needed to confirm these results.