Left atrial appendage occlusion was associated with a similar risk of all-cause mortality, ischemic stroke, and major bleeding compared with switching DOACs (HR 0.94; 95% CI 0.80-1.12; P=0.516).
Cohort (n=2,350)
Does left atrial appendage occlusion reduce the composite of all-cause mortality, ischemic stroke, and major bleeding compared to switching direct oral anticoagulants in patients with atrial fibrillation?
LAAO provides comparable overall safety and efficacy to switching DOACs in AF patients, with potentially lower long-term mortality and bleeding risks.
Hazard Ratio: 0.94 (95% CI 0.8–1.12)
Absolute Event Rate: 24.6% vs 22.7%
p-value: p=0.516
Background Left atrial appendage occlusion (LAAO) has emerged as an alternative to oral anticoagulation therapy for stroke prevention in atrial fibrillation, but data comparing LAAO with direct oral anticoagulant (DOAC) are sparse. Methods and Results This cohort study compared LAAO (with or without prior anticoagulation) with a switch of one DOAC to another DOAC by 1:2 propensity score matching. The primary outcome was a composite of all‐cause mortality, ischemic stroke, and major bleeding. A total of 2350 patients (874 in the LAAO group and 1476 in the DOAC switch group) were included. After a mean follow‐up of 1052±694 days, the primary outcome developed in 215 (24.6%) patients in the LAAO group and in 335 (22.7%) patients in the DOAC switch group (hazard ratio HR, 0.94 95% CI, 0.80–1.12; P =0.516). The LAAO group had a lower all‐cause mortality (HR, 0.49 95% CI, 0.39–0.60; P <0.001) and cardiovascular mortality (HR, 0.49 95% CI, 0.32–0.73; P <0.001) but similar risk of ischemic stroke (HR, 0.83 95% CI, 0.63–1.10; P =0.194). The major bleeding risk was similar overall (HR, 1.18 95% CI, 0.94–1.48, P =0.150) but was lower in the LAAO group after 6 months (HR, 0.71 95% CI, 0.51–0.97; P =0.032). Conclusions LAAO conferred a similar risk of composite outcome of all‐cause mortality, ischemic stroke, and major bleeding, as compared with DOAC switch. The risks of all‐cause mortality and cardiovascular mortality were lower with LAAO.
Ng et al. (Sat,) conducted a cohort in Atrial Fibrillation (n=2,350). Left atrial appendage occlusion (LAAO) vs. Switch of one DOAC to another DOAC was evaluated on Composite of all-cause mortality, ischemic stroke, and major bleeding (HR 0.94, 95% CI 0.80-1.12, p=0.516). Left atrial appendage occlusion was associated with a similar risk of all-cause mortality, ischemic stroke, and major bleeding compared with switching DOACs (HR 0.94; 95% CI 0.80-1.12; P=0.516).