Key result
LAAC cuts all strokes ~32% vs OAC in AF, driven by fewer hemorrhagic strokes.
Why the study?
The study was conducted to compare the clinical results of left atrial appendage closure (LAAC) and oral anticoagulation (OAC) in individuals with AF.
Does Left Atrial Appendage Closure (LAAC) reduce the risk of stroke and systemic embolization in patients with atrial fibrillation compared to oral anticoagulation?
Meta-Analysis (n=6,286)
Yes
Does Left Atrial Appendage Closure (LAAC) reduce the risk of stroke and systemic embolization in patients with atrial fibrillation compared to oral anticoagulation?
Effect estimate: OR 0.68 (95% CI 0.55-0.84)
p-value: p=0.0004
In patients with atrial fibrillation, LAAC is associated with a significantly lower risk of all strokes and hemorrhagic strokes compared to oral anticoagulation, while providing comparable protection against ischemic stroke and systemic embolization.
Favors LAAC over OAC for AF stroke prevention; challenges mixed prior anticoagulation evidence.
BACKGROUND: The purpose of this study is to compare the clinical results of Left Atrial Appendage Closure (LAAC) and oral anticoagulation (OAC) in individuals with AF. METHODS: For randomized controlled trials (RCTs) comparing the clinical results of OAC to LAAC in patients with atrial fibrillation (AF), we searched PubMed, ScienceDirect, and Cochrane. The included publications were subjected to meta-analyses using Review Manager v5.4. RESULTS: In comparison to OAC, LAAC was linked with a decreased incidence of all stroke (OR 0.68; 95% CI 0.55-0.84; p = 0.0004). LAAC was also linked to a decreased risk of hemorrhagic stroke (OR 0.20, 95% CI 0.07-0.55; p = 0.002). There is no statistically significant difference between the two groups in terms of ischemic stroke (OR 1.05; 95% CI 0.59-1.84; p = 0.88) or systemic embolization (OR 1.02; 95% CI 0.42-2.46; p = 0.97). CONCLUSIONS: According to our meta-analysis, the LAAC was less likely than the OAC to have a complete or hemorrhagic stroke. For the two groups, however, there was no difference in the risk of ischemic stroke or systemic embolization.
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Pramana et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=6,286). Left Atrial Appendage Closure (LAAC) vs. Oral anticoagulant therapy (OAC) was evaluated on All strokes (OR 0.68, 95% CI 0.55-0.84, p=0.0004). Left atrial appendage closure significantly reduced the odds of all strokes (OR 0.68) and hemorrhagic strokes (OR 0.20) compared to oral anticoagulation in patients with atrial fibrillation.
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