Antithrombotic Therapy After Left Atrial Appendage Occlusion: The SIMPLAAFY Randomized Clinical Trial.

Reduced-dose NOACs and aspirin alone are noninferior to 6-month dual antiplatelet therapy after uncomplicated left atrial appendage closure, with primary events 5.1% and 3.3% versus 6.9%.

• Why it matters: After LAAC, antithrombotic therapy is needed to support device endothelialization, but the best postimplant regimen is uncertain.
• What they did: In an open-label, 3-group multicenter randomized trial of 1857 patients with nonvalvular atrial fibrillation, participants received DAPT for 6 months then aspirin, reduced-dose NOAC for 3 months then aspirin, or aspirin alone for 12 months.
• The result: The 6-month composite of death, stroke, systemic embolism, or major bleeding occurred in 41 (6.9%) with DAPT, 31 (5.1%) with reduced-dose NOAC, and 20 (3.3%) with aspirin alone; both monotherapy strategies met noninferiority (P<.001).

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