Left atrial appendage closure lacks sufficient evidence for routine use.
Does percutaneous left atrial appendage occlusion (pLAAO) provide sufficient evidence for routine use compared to NOACs in patients with atrial fibrillation?
The authors argue that current trial evidence is insufficient to support the routine use of percutaneous left atrial appendage occlusion as an alternative to NOACs in patients with atrial fibrillation.
Percutaneous left atrial appendage occlusion (pLAAO) is increasingly being adopted as an alternative to non-vitamin K antagonist oral anticoagulants (NOACs) for patients with atrial fibrillation. However, the current evidence does not justify this enthusiasm. Key limitations include wide non-inferiority margins in some of the trials, inclusion of components in the primary efficacy endpoint that are not directly influenced by pLAAO, making non-inferiority easier to achieve, limited statistical power to detect differences in ischemic stroke or systemic embolism, and an overstated bleeding advantage.
Ruzieh et al. (Wed,) conducted a editorial in Left Atrial Appendage Closure. Left Atrial Appendage Closure was evaluated. Left atrial appendage closure lacks sufficient evidence for routine use.