Key result
LAAO shows comparable mortality to oral anticoagulation but increases ischemic stroke risk.
Why the study?
Data comparing left atrial appendage occlusion with contemporary oral anticoagulation remain uncertain, especially with newer direct oral anticoagulants.
Does left atrial appendage occlusion reduce all-cause mortality compared to oral anticoagulation in patients with atrial fibrillation?
Meta-Analysis (n=7,004)
Yes
Does left atrial appendage occlusion reduce all-cause mortality compared to oral anticoagulation in patients with atrial fibrillation?
Relative Risk: 1.03 (95% CI 0.87–1.22)
p-value: p=0.65
In patients with atrial fibrillation, LAAO provides comparable overall survival to oral anticoagulation but increases the risk of ischemic stroke while reducing non-major bleeding, warranting a cautious and individualized approach to its use.
Reaffirms oral anticoagulation as the preferred first-line therapy for stroke prevention in AF; challenges.
Background Data comparing left atrial appendage occlusion (LAAO) with contemporary oral anticoagulation (OAC) remain uncertain, particularly in the era of safer and more effective direct oral anticoagulants. We investigated the comparative safety and efficacy of LAAO and OAC in patients with atrial fibrillation. Methods We conducted a systematic literature search of MEDLINE, EMBASE, and Cochrane from January 2000 to April 2026, to identify eligible randomized controlled trials comparing LAAO to OAC in patients with atrial fibrillation. The primary outcome was all-cause mortality. Secondary outcomes were ischemic stroke, major and non-major bleeding, and systemic embolism. Pooled effect sizes were calculated using fixed or random effects models and expressed as risk ratios (RR) or mean difference (MD) with 95% confidence intervals. Results Six RCTs comprising 7004 patients (LAAO: 3681; OAC: 3323) were included. There was no statistically significant difference in all-cause mortality between groups (RR 1.03, 95% CI 0.87-1.22, p = 0.65; I²=0.0%). LAAO was associated with a significantly higher risk of ischemic stroke compared to OAC (RR 1.32, 95% CI 1.04-1.68, p = 0.03; I²=0%). Non-major bleeding was significantly reduced with LAAO (RR 0.50, 95% CI 0.43-0.58, p = 0.002; I²=0%) with no statistical difference in the major bleeding outcome (RR 0.92, 95% CI 0.73-1.16, p = 0.38; I²=0%). We found no significant difference between groups in terms of systemic embolism (RR 1.29, 95% CI 0.41-4.07, p = 0.60; I²=0%). Conclusions LAAO was associated with a significantly higher ischemic stroke risk, while reducing non-major bleeding, however with no significant reduction in the major bleeding outcome overall. Additionally, groups were comparable in terms of all-cause mortality, and systemic embolism. These findings support a cautious, individualized approach to LAAO adoption in clinical practice.
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Gonnah et al. (2026) conducted a meta-analysis in atrial fibrillation (n=7,004). Left atrial appendage occlusion vs. Oral anticoagulation or physician-directed medical therapy was evaluated on all-cause mortality (RR 1.03, 95% CI 0.87-1.22, p=0.65). Left atrial appendage occlusion resulted in comparable all-cause mortality (RR 1.03) but increased ischemic stroke risk (RR 1.32) and reduced non-major bleeding (RR 0.50) compared to oral anticoagulation.
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