September 17, 2026New England Journal of Medicine
Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
DCDr. Christine Albert
“The data ‘give you pause’ when considering closure, especially for women who can tolerate DOACs. We haven't proven beyond a shadow of a doubt that these procedures are equivalent for every single patient. So I do think it's useful to have these data [from CLOSURE-AF].”
DIDr. Ingo Eitel
“Probably women have a dedicated protection... from systemic anticoagulation with DOACs, for example. We clearly have to conclude that sex may matter when we select for left atrial appendage occlusion procedures.”
“These positive data, which have the potential to support updated clinical guidelines globally, will be used in our submission to expand the indication and coverage for the well-established WATCHMAN platform as a first-line stroke risk reduction option, providing physicians with more choices in care for a wider range of patients who have atrial fibrillation. Today, 40% of patients with AF who are prescribed blood thinners for stroke risk reduction are not taking their medications consistently, significantly increasing their risk of...”
Overview
Comparative study evaluates stroke prevention and bleeding rates in atrial fibrillation, indicating mechanical closure provides a viable alternative to oral anticoagulants.
New in NEJM. For AF patients: appendage closure weighed against anticoagulation in NEJM. Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation Left atrial appendage closure demonstrates durable prevention against thromboembolism and ischemic stroke comparable to systemic anticoagulation therapy. Mechanical closure substantially reduces subsequent long-term major bleeding episodes by removing the requirement for indefinite anticoagulant administration. Where experts stand: Dr. Brad Sutton (Chief Medical Officer, Atrial Fibrillation…): “These positive data, which have the potential to support updated clinical guidelines globally, will be used in our submission to expand the…” From their public comments on the paper Read the evidence. See where experts stand. synapsesocial.com/papers/6aabafdb20b725bb9d86f004
Key Points
- To evaluate the clinical efficacy and safety of percutaneous left atrial appendage closure compared with systemic oral anticoagulation for stroke prevention in patients with atrial fibrillation.
- Comparative clinical evaluation contrasting mechanical left atrial appendage occlusion devices against pharmacological oral anticoagulation regimens.
- Longitudinal tracking of primary clinical endpoints, focusing on ischemic stroke, systemic embolic events, major bleeding, and procedure-related adverse events.
- Left atrial appendage closure demonstrates durable prevention against thromboembolism and ischemic stroke comparable to systemic anticoagulation therapy.
- Mechanical closure substantially reduces subsequent long-term major bleeding episodes by removing the requirement for indefinite anticoagulant administration.
Cite This Study
A 2026 study studied this question.