B-35 | Outcomes of Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Meta-Analysis

Atrial fibrillation (AF) remains a significant burden on the global population, serving as the leading cardiac cause of preventable ischemic stroke. While direct oral anticoagulants (DOACs) are the mainstay in preventing stroke in those with non-valvular AF, left atrial appendage occlusion closure devices (LAAC) have become increasingly popular. We aimed to evaluate outcomes of DOACs versus LAAC in patients with non-valvular AF. We searched multiple databases for studies comparing DOACs versus LAAC in patients with non-valvular AF. We used a common-effect model to calculate risk ratios (RR) with 95% confidence intervals in R studio. Outcomes assessed were all-cause mortality, cardiovascular mortality, device embolization, stroke, and major vascular complications. A total of 6 studies were identified consisting of 7025 patients with non-valvular AF, of which 4013 received DOACs and 3012 underwent LAAC. Compared to LAAC, DOACs were associated with significantly increased risks of all-cause mortality (RR 1.79; 95% CI 1.54 - 2.07), and cardiovascular mortality (RR 1.78; 95% CI 1.36 - 2.33). Device embolization (RR 0.22; 95% CI 0.04 - 1.36) and stroke (RR 0.91; 95% CI 0.47 - 1.74) were similar in both groups while major vascular complications (RR 0.06; 95% CI 0.01 - 0.32) were significantly decreased in DOACs compared to LAAC. This meta-analysis found that DOACs were associated with an increased risk of all-cause mortality and cardiovascular mortality, along with a decreased risk of major vascular complications when compared to LAAC in those with non-valvular AF. Further studies are needed to confirm our findings.