Comparison between Left Atrial Appendage Closure and Direct Oral Anticoagulants in Atrial Fibrillation: A Meta-analysis of 569780 Patients

Background: Percutaneous left atrial appendage closure (LAAC), which lowers bleeding risk and mortality, has been shown in multiple studies to be a safe substitute for oral anticoagulation (OAC) in atrial fibrillation (AF) patients. It has been demonstrated that in patients at high risk of bleeding, LAAC reduces bleeding more than OAC. The purpose of the current systematic review and meta-analysis is to compare the two therapy methods regarding bleeding risk as well as other safety and efficacious outcomes, as there is insufficient evidence to support the use of LAAC rather than direct oral anticoagulants (DOACs) in AF patients. Methods: Using the following search strategy: ‘Left atrial’ AND ‘appendage’ AND ‘Atrial fibrillation’ AND ‘Anticoagulant’ OR ‘Anti-coagulant’ OR ‘Anticoagulation’, we searched PubMed, Web of Science and Scopus for eligible articles that should undergo the screening process to determine its ability to be included in our study. Results: The use of LAAC in AF patients was associated with lower risk of bleeding compared to patients taking DOAC with OR of 0.67 (95% CI: 0.51, 0.87, P = 0.02), and decreased risk of cardiac mortality compared to DOAC with OR of 0.53 (95% CI: 0.39, 0.73, P < 0.0001). No significant differences were observed between LAAC and DOAC regarding all-cause mortality, stroke incidence and thrombosis or embolism with OR of 2.62 (95% CI: 0.14, 48.18, P = 0.52), 1.2 (95% CI: 0.18, 7.96, P = 0.85) and 1.03 (95% CI: 0.73, 1.46, P = 0.86), respectively. Conclusion: The current meta-analysis contrasted various AF patient outcomes following the use of DOAC or LAAC. When compared to DOAC, the usage of LAAC was found to reduce the risk of bleeding and cardiac death. Regarding the incidence of all cause death, stroke risk and thrombosis or embolism risk, however, their findings were similar.