Abstract 11947: Left Atrial Appendage Closure vs Oral Anticoagulation in Atrial Fibrillation: A Contemporary Bayesian Meta-Analysis of Randomized Trials

Background: Atrial fibrillation (AF) is a major cause of stroke and cardiovascular mortality. Although oral anticoagulation remains the standard strategy for stroke prevention, long-term treatment may be limited by bleeding risk, contraindications, and adherence challenges. Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative approach, but randomized evidence remains mixed. Research Question: Does percutaneous LAAC provide comparable efficacy and safety to oral anticoagulation in patients with AF? Methods: We performed a systematic review and Bayesian meta-analysis of randomized controlled trials comparing percutaneous LAAC with oral anticoagulation in adults with AF. PubMed, Embase, and CENTRAL were systematically searched. Bayesian random-effects models were used to estimate odds ratios (ORs) with 95% credible intervals (CrIs) and posterior probabilities of benefit (OR <1.00) or harm (OR >1.00). Results: Six randomized controlled trials and one pooled analysis comprising 7,004 patients were included. For the primary composite outcome, LAAC demonstrated an OR of 0.83 (95% CrI 0.58-1.16), corresponding to an 88.72% posterior probability of benefit. No clear differences were observed for all-cause mortality (OR 0.90; 95% CrI 0.69-1.18) or cardiovascular mortality (OR 0.94; 95% CrI 0.65-1.33). Major bleeding favored LAAC (OR 0.87; 95% CrI 0.67-1.14), with an 85.86% probability of benefit. Stroke outcomes remained uncertain (OR 1.06; 95% CrI 0.73-1.54), with a 63.35% posterior probability of harm. Conclusions: In patients with AF, LAAC demonstrated a high probability of benefit for composite clinical outcomes and major bleeding, while mortality outcomes were comparable to oral anticoagulation. However, uncertainty regarding stroke risk persists, supporting a selective and individualized approach to patient selection.