The use of direct oral anticoagulants (DOAC) following transcatheter left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (AFib) was not superior to DAPT in preventing device-related thrombosis (DRT), based on findings from the ANDES trial presented at TCT 2025 and simultaneously published in Circulation. However, researchers did note DOAC use was associated with an improved safety profile.

In what is the largest trial to date comparing DOAC with DAPT for transcatheter LAAC, researchers randomized 510 patients (average age of 77 years; 35% women) to DOAC or DAPT. The primary outcome was DRT as determined by transesophageal echocardiography (TEE) at 60 days after LAAC. The primary safety outcome included all-cause mortality, stroke, bleeding or DRT.

Of the 399 patients who ultimately underwent TEE and were receiving the allocated treatment at 60 days after LAAC, the primary outcome occurred in 3 patients (1.5%) receiving DOACs and 8 patients (4.1%) receiving DAPT. The safety outcome occurred in 52 patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in the DAPT groups, largely due to a lower rate of bleeding events among those assigned to DOACs. Researchers cautioned that the results should be confirmed in future larger studies.

"While waiting for further evidence, these findings suggest that the short-term use of DOAC may be a reasonable and likely safer antithrombotic strategy in LAAO recipients," said Josep Rodés-Cabau, MD, PhD, in presenting the findings.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Transcatheter Cardiovascular Therapeutics, TCT25, Arrhythmias, Cardiac, Anticoagulants, Angiography