Bogdan Enache, MD

Cardiology Pharmaceuticals

Reconsidering LAAO Postprocedural Management

Real-world data from the EMERGE LAA postapproval study suggests it might be time to rethink the discharge medications prescribed to patients after LAAO.

• Current antithrombotic recommendations call for both aspirin and clopidogrel (or another antiplatelet drug) for six months, with therapy continuation as prescribed by a physician.
• Oral anticoagulation is usually for patients whose residual flow around the LAA implant is more than 5 mm.

Diving deeper into data from Abbott’s 11.5k patient EMERGE LAA postapproval study, researchers compared the adverse events and six month outcomes of single antiplatelet therapy (5.3% of patients), DAPT (81.7%), and oral anticoagulants (13%), finding that there weren’t many differences across the board.

• The composite rate of all-cause death, stroke, major bleeding, or systemic embolism was 5.5% with SAPT, 6.9% with DAPT, and 4.9% with oral anticoagulants after six months.
• Major bleeding was highest in the DAPT group at 3.8%, compared with 3.1% with SAPT and 2.5% with oral anticoagulants.

While oral anticoagulants led to the lowest complication rates following implantation, the close performance of SAPT (which was either just aspirin or a P2Y12 inhibitor) could provide an affordable over-the-counter alternative to prescription drugs.

• While this analysis doesn’t tell us how many patients received which monotherapy, other studies have supported P2Y12 inhibitors over aspirin.
• As a result, the authors of EMERGE LAA are calling for randomized controlled trials that would focus solely on LAAO postprocedure management.

The Takeaway

Based on this analysis, the idea of an OTC discharge therapy sounds possible, but a head-to-dead RCT for all three options is needed to pave a clearer path for the physicians prescribing these treatments. On the bright side, at least we know none of the three treatment options are the wrong answer.

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