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July 11, 2026CureusOpen Access

LAAC shows no significant difference versus OAC for stroke, systemic embolism, and CV death.

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Why the study?

While early randomized trials established non-inferiority of LAAC versus warfarin, the comparative effectiveness of LAAC against direct oral anticoagulants remains less well characterized.

Does percutaneous left atrial appendage closure reduce the composite of stroke, systemic embolism, and cardiovascular death compared to oral anticoagulation in adults with non-valvular atrial fibrillation?

Comparison

Percutaneous LAAC vs oral anticoagulation (warfarin or DOACs)

Design

Systematic review and meta-analysis of randomized controlled trials

Key result

Left atrial appendage closure demonstrated no significant difference in the composite of stroke, systemic embolism, and cardiovascular death compared to oral anticoagulation (RR 0.90).

Authors

USUday Shree Akkala ShettyHGHimashi GunaratneASAshutosh Sharma

Discussion

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Overview

LAAC offers comparable stroke prevention with lower bleeding versus OAC in AF; reinforces consensus from prior RCTs.

Key Points

  • This review aims to compare the effectiveness of left atrial appendage closure and oral anticoagulation for stroke prevention in non-valvular atrial fibrillation.
  • Systematic review and meta-analysis of randomized controlled trials.
  • Included 5 RCTs with a total of 6,116 patients.
  • Primary outcome was composite of stroke, systemic embolism, and cardiovascular death.
  • No significant difference in composite primary outcome between LAAC and oral anticoagulation (RR 0.90; 95% CI 0.71-1.14).
  • LAAC significantly reduced major bleeding events by 24% compared to anticoagulation (RR 0.76; 95% CI 0.61-0.94).
  • Subgroup analysis indicated greater efficacy of LAAC over warfarin (RR 0.69) but similar to DOACs (RR 0.98).

Study Design

Type

Meta-Analysis (n=6,116)

Blinding

Open-label

Multicenter

Yes

Structured PICO

Does percutaneous left atrial appendage closure reduce the composite of stroke, systemic embolism, and cardiovascular death compared to oral anticoagulation in adults with non-valvular atrial fibrillation?

P
Population
6,116 adults with non-valvular atrial fibrillation across 5 randomized controlled trials followed for 2 to 4 years.
I
Intervention
Percutaneous left atrial appendage closure (LAAC)
C
Comparator
Oral anticoagulation (either warfarin or direct oral anticoagulants [DOACs])
O
Outcome
Composite of stroke, systemic embolism (SE), and cardiovascular deathcomposite

Main Result

Relative Risk: 0.9 (95% CI 0.71–1.14)

LAAC provides comparable thromboembolic protection to oral anticoagulation in non-valvular AF while significantly reducing major bleeding, supporting its use as a viable alternative for patients at elevated bleeding risk.

Limitations

  • Only five randomized controlled trials were included, limiting the overall sample size and statistical power.
  • Only one warfarin-based trial contributed to the major bleeding subgroup analysis.
  • Individual patient-level data were unavailable, preventing detailed adjusted and subgroup analyses.
  • Relatively short follow-up duration across studies may underestimate long-term differences.
  • Variations in post-LAAC antithrombotic regimens and endpoint definitions across trials.

Cite This Study

Shetty et al. (2026) conducted a meta-analysis in Non-valvular atrial fibrillation (n=6,116). Percutaneous left atrial appendage closure (LAAC) vs. Oral anticoagulation (warfarin or DOACs) was evaluated on Composite of stroke, systemic embolism, and cardiovascular death (RR 0.90, 95% CI 0.71-1.14). Left atrial appendage closure demonstrated no significant difference in the composite of stroke, systemic embolism, and cardiovascular death compared to oral anticoagulation (RR 0.90).

synapsesocial.com/papers/6a51e44fc18d7f28ca501706https://doi.org/10.7759/cureus.112357
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990–2019: results from a global burden of disease study, 20192022 · 198 citations
  2. 2Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.1991 · 7,523 citations
  3. 3Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: Long-term outcomes from 4 randomized trials2025 · 26 citations
  4. 4Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation2026 · 65 citations
  5. 5Left Atrial Appendage Closure after Ablation for Atrial Fibrillation2024 · 225 citations