Atrial fibrillation (AF)  is a common cardiac arrhythmia associated with a high risk of stroke and thromboembolic events. Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative to oral anticoagulation therapy, yet the optimal antithrombotic strategy post-procedure remains unclear.Aim: To compare the safety and efficacy of low-dose direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAO.

A comprehensive literature search was conducted in October 2024 across PubMed, Scopus, Cochrane, and Web of Science databases. Inclusion criteria encompassed adults aged 18 and older with AF who underwent successful LAAO. Primary outcomes included device-related thrombosis (DRT), major bleeding, and thromboembolic outcomes (strokes and systemic embolism (SE)). Statistical analysis was conducted using R version 4.3.2.

 Four studies involving 727 patients were included, comprising two randomized controlled trials and two cohort studies Low-dose DOAC therapy significantly reduced the risk of DRT by 64% compared to DAPT (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011), and also demonstrated superior efficacy (OR = 0.36; 95% CI [0.16, 0.85], p = 0.01). However, there wasn't a significant difference in the incidence of major bleeding (OR = 0.36; 95% CI [0.11, 1.18], p = 0.091; I² = 0%). The composite endpoint of efficacy and safety outcomes was significantly reduced in the low-dose DOAC group  (OR = 0.41; 95% CI [0.25, 0.67], p = 0.0003; I² = 0%).

Our findings suggest low-dose DOACs are safer and more effective antithrombotic option than DAPT in patients with AF following LAAO. Our findings has shown better clinical outcomes and lower rates of complications. Further research is warranted to establish long-term safety and efficacy in large control clinical trialsKeywordsAtrial fibrillation, Left atrial appendage occlusion,  Low-dose direct oral anticoagulant, Dual antiplatelet therapy, Device-related thrombosis