Antiplatelet monotherapy was noninferior to dual therapy after uncomplicated LAAC

The SIMPLAAFY trial found that aspirin alone and reduced-dose non-vitamin K antagonist oral anticoagulants (NOACs) were noninferior to dual antiplatelet therapy (DAPT) for a composite of death, stroke, systemic embolism or major bleeding 6 months after uncomplicated left atrial appendage closure. The study was presented at the TCT conference and published in JAMA.

Researchers randomized 1,857 patients who received a Watchman FLX Pro device to aspirin alone, reduced-dose NOAC for 3 months followed by aspirin, or DAPT for 6 months followed by aspirin. The composite outcome occurred in 3.3% of the aspirin group, 5.1% of the reduced-dose NOAC group and 6.9% of the DAPT group, MedPage Today reported. Ischemic stroke rates were 0.7% in each group, according to Healio. Both monotherapy groups had lower bleeding risk than the DAPT group, and device-related thrombus at 45 days was lowest with reduced-dose NOAC, at 0.9%.

The findings apply to uncomplicated implants, and the reports noted that some high-risk patients were excluded. The trial had no prespecified comparison between the two monotherapy groups. The 12-month results are pending.