Key result
LAAC cuts stroke, cardiovascular death, and systemic embolism by ~25% versus anticoagulation.
Why the study?
Left atrial appendage closure offers a minimally invasive nonpharmacological alternative to first-line anticoagulants for stroke prevention in atrial fibrillation.
Does left atrial appendage closure reduce the composite of hemorrhagic stroke, all-cause mortality, and non-procedural major bleeding in adult patients with atrial fibrillation compared to oral anticoagulation therapy?
Meta-Analysis (n=1,516)
Open-label
Randomized controlled trials included
Yes
Does left atrial appendage closure reduce the composite of hemorrhagic stroke, all-cause mortality, and non-procedural major bleeding in adult patients with atrial fibrillation compared to oral anticoagulation therapy?
Relative Risk: 0.75 (95% CI 0.57–1)
p-value: p=0.05
LAAC is a viable alternative to oral anticoagulation in AF patients, offering comparable stroke prevention with reduced risks of mortality and nonprocedural bleeding.
Supports LAA closure over anticoagulation for the composite outcome in AF; confirms superiority in pooled randomized evidence.
Background: Left atrial appendage closure (LACC) is a nonpharmacological option for individuals with atrial fibrillation (AF). LAAC procedure is characterized by its minimally invasive nature and is considered an alternative to anticoagulants that were usually the first line of treatment for patients at risk for blood clotting. Methods: A literature search of three databases was conducted and relevant randomized controlled trials (RCTs) were selected. A meta-analysis was performed using a random effect model to calculate risk ratios with 95% confidence intervals, and only the articles with the longest follow-up were included in the meta-regression analysis. Bias was assessed using standard methodologies. We included RCTs involving adult patients with AF that compared LAAC with oral anticoagulation therapy. Non-randomized studies, case series, animal studies, and non-English publications were excluded. Results: We included three studies with a 1516 sample size. All three trials investigated the composite hemorrhagic stroke, all-cause mortality, and non-procedural major bleeding as primary outcomes in addition to the risk of systematic embolism, ischemic stroke, and all major bleeding. Compared to anticoagulation medical therapy, the LAAC device showed a statistically significant reduction in the risk of the composite primary outcome, cardiovascular (CV) death, all-cause deaths, and nonprocedural bleed. When compared to medical management, there was no statistically significant difference in the risk of systemic embolism and all-stroke in the LAAC device group. The age had no significant impact on the primary efficacy outcome using the Meta-regression analysis. Conclusion: LAAC has comparable efficacy in preventing strokes. The risk of CV death, all-cause deaths, and nonprocedural relevant bleeding, all of which are associated with the composite primary outcome is lower in the LAAC group versus the oral anticoagulation therapy and can have even greater efficacy with a longer follow-up period.
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Singh et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=1,516). Left atrial appendage closure (LAAC) vs. Oral anticoagulation therapy was evaluated on Composite of stroke, cardiovascular death, and systemic embolism (RR 0.75, 95% CI 0.57-1.00, p=0.05). Left atrial appendage closure demonstrated superior efficacy in reducing the composite primary outcome of stroke, cardiovascular death, and systemic embolism compared to anticoagulation (RR 0.75).
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