Outcomes of LAAO vs. DOACs in Obese Patients With Atrial Fibrillation a 5‐Year Propensity‐Matched Analysis

BACKGROUND: Obese patients with atrial fibrillation (AF) are at an increased risk of thromboembolic and bleeding events. While direct oral anticoagulants (DOACs) are the standard therapy for stroke prevention in AF, their use is associated with a significant bleeding risk in this population. Comparative data of left appendage atrial occlusion (LAAO) vs. DOACs in this group are currently lacking. OBJECTIVE: To compare the 5-year clinical outcomes of LAAO vs. DOACs in obese patients with AF. METHODS: ). Two cohorts were defined: those undergoing LAAO (n = 1571) and those treated with DOACs (n = 103,047). Propensity score matching was conducted to adjust for demographics, comorbidities, and stroke/bleeding risk scores, resulting in matched cohorts of 1566 patients each. Outcomes assessed included ischemic stroke, non-traumatic intracranial hemorrhage, major bleeding, MI, and all-cause mortality. Kaplan-Meier survival curves and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for group comparisons. RESULTS: At 5 years, stroke rates were similar between LAAO and DOAC groups (HR:1.00; 95% CI: 0.69-1.43; p = 0.984), as were major bleeding rates similar (HR:0.99; 95% CI: 0.71-1.42; p = 0.969). MI risk was comparable between the groups (HR:1.05; 95% CI: 0.66-1.36; p = 0.772). Importantly, LAAO was associated with lower all-cause mortality (HR:0.64; 95% CI: 0.54-0.76; p < 0.001). CONCLUSIONS: In obese patients with AF, LAAO offers a comparable stroke and bleeding protection to DOACs, while reducing all-cause mortality over 5 years. These findings underscore the potential of LAAO as a long-term strategy for stroke prevention in this high-risk population.