Key result
NOAC monotherapy post-LAAC yields similar major events to warfarin but reduces total bleeding.
Why the study?
There is no consensus on the selection between NOAC and warfarin monotherapy after left atrial appendage closure.
Does NOAC monotherapy reduce major adverse events or bleeding compared to warfarin monotherapy in patients undergoing left atrial appendage closure?
Meta-Analysis (n=10,337)
Does NOAC monotherapy reduce major adverse events or bleeding compared to warfarin monotherapy in patients undergoing left atrial appendage closure?
In patients undergoing left atrial appendage closure, NOAC monotherapy for 45 days is associated with a significantly lower risk of total bleeding compared to warfarin monotherapy, with similar rates of major adverse events.
Answers are grounded in this paper and cite their sources.
May favor NOAC monotherapy after LAA closure to reduce bleeding; meta-analysis extends prior evidence on post-procedural antithrombotic choices.
Background Pivotal trials of percutaneous left atrial appendage closure (LAAC) used dedicated post-procedure antithrombotic protocols. However, there is no consensus on the selection of new oral anticoagulants (NOAC) and warfarin monotherapy after LAAC. This study aims to compare NOAC with warfarin monotherapy for efficacy and safety in patients undergoing LAAC. Methods A database search was conducted using PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov for trials that compared NOAC with warfarin monotherapy after LAAC. The effective outcomes included any major adverse events (all-cause death, stroke, major bleeding) and their individual components. Safety outcomes included all-cause death, major bleeding, total bleeding, DRT, and PDL >5 mm. Results We included 10 non-randomized clinical trials with 10,337 patients, of whom 4,960 patients received NOAC, while 5,377 patients received warfarin. There were no statistically significant differences in any major adverse events (LogOR: −0.11, 95% CI: −0.27, 0.04, P = 0.16), stroke (LogOR: 0.00, 95% CI: −0.42, 0.42, P = 1.00), all-cause death (LogOR: −0.23, 95% CI: −0.48, 0.02, P = 0.07), major bleeding (LogOR: −0.22, 95% CI: −0.45, 0.01, P = 0.06). NOAC was associated with a significant reduction in total bleeding (LogOR: −1.01, 95% CI: −1.47, −0.55, P < 0.0001) compared to warfarin. No statistically significant differences were found in DRT (LogOR: −0.19, 95% CI: −0.15, 0.52, P = 0.27) and PDL >5 mm (LogOR: 0.19, 95% CI: −0.33, 0.72, P = 0.47). Meta-regression and subgroup analysis showed that total bleeding (LogOR: −1.56, 95% CI: −2.15, −0.97, P < 0.001) was significantly lower in the NOAC group in the subgroup of <75 y. Conclusion After LAAC, NOAC monotherapy was associated with a lower risk of bleeding compared to warfarin monotherapy for 45 days. There was no significant difference between NOAC and warfarin in terms of other results. Systematic review registration www.york.ac.uk/inst/crd , identifier: CRD42022361244.
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Sun et al. (2022) conducted a meta-analysis in Left atrial appendage closure (n=10,337). New oral anticoagulants (NOAC) vs. Warfarin monotherapy was evaluated on Any major adverse events (all-cause death, stroke, major bleeding) (LogOR -0.11, 95% CI -0.27, 0.04, p=0.16). NOAC monotherapy after left atrial appendage closure showed no significant difference in major adverse events compared to warfarin (LogOR -0.11; 95% CI -0.27 to 0.04; P=0.16), but reduced total bleeding.
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