Key result
LAAO is linked to favorable outcomes in OAC-ineligible patients but requires RCT confirmation.
While LAAO is FDA-approved based on trials in OAC-eligible patients, its real-world use is predominantly in OAC-ineligible patients, highlighting the need for randomized clinical trials in this specific population.
Highlights evidence gap for predominant real-world LAAO use; leaves open efficacy confirmation in OAC-ineligible patients.
Percutaneous left atrial appendage occlusion (LAAO) is a device-based therapy for the prevention of stroke in patients with non-valvular atrial fibrillation (AF). Recently, the Watchman device (Boston Scientific, St Paul, MN, US) was approved in the US by the Food and Drug Administration (FDA) based on the results of two randomised clinical trials that evaluated LAAO in patients eligible for oral anticoagulation (OAC) therapy. However, in real-word clinical practice LAAO is typically offered to patients ineligible for OAC therapy, as they appear to have limited treatment options and consequently worse prognosis. Although LAAO has shown favourable clinical outcomes in OAC-ineligible patients in single or multicentre observational studies, these results need to be confirmed in randomised clinical trials.
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Apostolos et al. (2015) conducted a review in non-valvular atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) was evaluated. Left atrial appendage occlusion has shown favorable clinical outcomes in OAC-ineligible patients in observational studies, but these results require confirmation in randomized clinical trials.
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