Key result
Left atrial appendage occlusion resulted in comparable cardiovascular mortality compared to direct oral anticoagulants (5.4% vs 8.3%; RR 0.90) in patients with nonvalvular atrial fibrillation.
Why the study?
The long-term efficacy and safety of direct oral anticoagulants versus left atrial appendage occlusion in patients with atrial fibrillation remained unknown.
Does Left Atrial Appendage Occlusion (LAAO) reduce cardiovascular mortality compared to Direct Oral Anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation?
Meta-Analysis (n=3,039)
Does Left Atrial Appendage Occlusion (LAAO) reduce cardiovascular mortality compared to Direct Oral Anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation?
Relative Risk: 0.9 (95% CI 0.4–2.03)
Absolute Event Rate: 5.4% vs 8.3%
p-value: p=0.81
In patients with nonvalvular atrial fibrillation, LAAO provides comparable long-term efficacy and safety to DOACs for stroke prevention.
Background: Prevention of stroke by anticoagulation is essential in patients with Atrial fibrillation (AF); with direct oral anticoagulants (DOACs) being preferred over warfarin in most patients. The Long-term efficacy and safety of DOACs vs. Left Atrial Appendage Occlusion (LAAO) remain unknown. Methods: Electronic databases (PubMed, Embase, Scopus) were searched from inception to February 10th, 2021. The primary endpoint was cardiovascular mortality. Secondary outcomes included incidence of ischemic stroke/transient ischemic attack (TIA) and systemicembolism. The safety endpoint was clinically relevant bleeding (a composite of major or minor clinically relevant bleeding). Results: A total of three studies with 3039 participants (LAAO = 1465; DOACs = 1574) were included. Mean age was 74.2 and 75.3 years in the LAAO and DOAC group respectively. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.90, 95% CI 0.40–2.03; p = 0.81), ischemic stroke/TIA (RR 1.15, 95% CI 0.80–1.65; p = 0.46; I2 = 0) and clinically significant bleeding (RR 0.77, 95% CI 0.50–1.17; p = 0.22; I2 = 69) between the groups. Conclusions: Among patients with AF, LAAO was comparable to DOACs with similar efficacy and safety profiles.
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Razzack et al. (2023) conducted a meta-analysis in Atrial Fibrillation (n=3,039). Left Atrial Appendage Occlusion (LAAO) vs. Direct Oral Anticoagulation (DOAC) was evaluated on Cardiovascular mortality (RR 0.90, 95% CI 0.40-2.03, p=0.81). Left atrial appendage occlusion resulted in comparable cardiovascular mortality compared to direct oral anticoagulants (5.4% vs 8.3%; RR 0.90) in patients with nonvalvular atrial fibrillation.
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