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Rafael Gomes: Is Dual Antiplatelet Therapy Still Necessary After LAAO?
Rafael Gomes/LinkedIn
Nov 7, 2026, 16:31

Rafael Gomes: Is Dual Antiplatelet Therapy Still Necessary After LAAO?

Rafael Gomes, Cardiologist, Echocardiographer, Ergometrist at Real Hospital Português, shared a post on LinkedIn about a recent article by Vivek Y. Reddy et al, published in JAMA, adding:

”TCTMD 2026 | SIMPLAAFY: Is Dual Antiplatelet Therapy Still Necessary After LAAO?

Following left atrial appendage occlusion (LAAO), the challenge is clear: prevent device-related thrombosis while minimizing bleeding in an already high-risk population.

The SIMPLAAFY randomized trial, simultaneously published in JAMA, provides important new evidence.

Study design

1,857 patients underwent successful WATCHMAN FLX Pro implantation (Boston Scientific) and were randomized to three antithrombotic strategies:

  • Dual antiplatelet therapy for six months (n equals 624).
  • Reduced-dose direct oral anticoagulant for three months (n equals 620).
  • Aspirin monotherapy (n equals 613).

Primary endpoint at 6 months

All-cause death, stroke, systemic embolism, or major bleeding:

  • Dual antiplatelet therapy: 6.9 percent.
  • Reduced-dose direct oral anticoagulant: 5.1 percent.
  • Aspirin monotherapy: 3.3 percent.

Both monotherapy strategies demonstrated noninferiority to dual antiplatelet therapy (p less than 0.001).

  • Bleeding and thrombotic outcomes

Major bleeding:

  • DAPT: 4.5 percent.
  • Reduced-dose DOAC: 2.7 percent.
  • Aspirin alone: 1.7 percent.

Ischemic stroke: 0.7 percent in all three groups.

Device-related thrombosis at 45 days:

  • DAPT: 3.4 percent.
  • Reduced-dose DOAC: 0.9 percent.
  • Aspirin alone: 2.7 percent.

What should we take from these findings?

The results challenge the routine use of DAPT after uncomplicated LAAO.

Aspirin monotherapy was associated with the lowest bleeding rates, while reduced-dose DOAC showed the lowest observed rate of device-related thrombosis.

However, these secondary findings were exploratory, and the trial was not powered to establish equivalence between strategies for individual thromboembolic outcomes.

Importantly, the results apply to selected patients treated with WATCHMAN FLX Pro, with clinical follow-up currently limited to six months.

The key question may no longer be whether we can simplify antithrombotic therapy after LAAO, but which patients benefit most from each strategy.”

Title: Antithrombotic Therapy After Left Atrial Appendage OcclusionThe SIMPLAAFY Randomized Clinical Trial

Authors: Vivek Y. Reddy, Walid I. Saliba, Thomas Waggoner, Devi G. Nair, Stanislav Weiner, Rudolph Evonich, Michael Hoskins, Andrew Dublin, Michael Rinaldi, Gaurang Gandhi, Jonathan W. Dukes, Madhu Reddy, David DeLurgio, Venkat R. Iyer, Ganesh Venkataraman, Ashish Sadhu, Vamsee Yaganti, Kevin Trulock, Douglas N. Gibson, Mohamad Alkhouli, Manish Shah, Shephal K. Doshi, Andrea Natale, Megan Coylewright, C. Michael Gibson, Ahmed A. Kolkailah, Wael A. Jaber, Krystal Leger, Elizabeth Matznick, Thomas Christen, Brad S. Sutton, Kenneth M. Stein, Saibal Kar

Rafael Gomes: Is Dual Antiplatelet Therapy Still Necessary After LAAO?

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Ahmed A. Kolkailah Andrea Natale Andrew Dublin Ashish Sadhu Brad S. Sutton C. Michael Gibson David DeLurgio Devi G. Nair Douglas N. Gibson Elizabeth Matznick Ganesh Venkataraman Gaurang Gandhi Health Hematology Hemostasis Hemostasis News Hemostasis Today Jonathan W. Dukes Kenneth M. Stein Kevin Trulock Krystal Leger Madhu Reddy Manish Shah Medicine Megan Coylewright Michael Hoskins Michael Rinaldi Mohamad Alkhouli Rafael Gomes Rudolph Evonich Saibal Kar Shephal K. Doshi Stanislav Weiner Thomas Christen Thomas Waggoner Vamsee Yaganti Venkat R. Iyer Vivek Y Reddy Wael A. Jaber Walid I. Saliba
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