Key result
LAAO shows no benefit over oral anticoagulation for composite major clinical outcomes.
Why the study?
Data comparing left atrial appendage occlusion (LAAO) to contemporary oral anticoagulants (OAC) in atrial fibrillation remain uncertain.
Does left atrial appendage occlusion reduce the composite outcome of all-cause mortality, stroke, systemic embolism, and major bleeding compared to oral anticoagulation in patients with atrial fibrillation?
Meta-Analysis (n=7,004)
Randomized controlled trials
Does left atrial appendage occlusion reduce the composite outcome of all-cause mortality, stroke, systemic embolism, and major bleeding compared to oral anticoagulation in patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Compared to oral anticoagulation in atrial fibrillation, left atrial appendage occlusion showed no difference in overall composite outcomes or major bleeding, but resulted in a higher risk of ischemic stroke and lower non-major bleeding, supporting an individualized approach to device adoption.
Background: Data comparing left atrial appendage occlusion (LAAO) to contemporary oral anticoagulants (OAC) in atrial fibrillation remains uncertain. Hypothesis: We investigated the safety and efficacy of LAAO versus OAC in patients with atrial fibrillation. Methods: We conducted a systematic literature search of PubMed, MEDLINE, Scopus, EMBASE, Web of Science (WOS) from inception to April 2026, to identify eligible randomized controlled trials. The primary outcome was composite outcomes (a composite of all-cause mortality, stroke, systemic embolism, major bleeding). Secondary outcomes were all-cause mortality, 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 composite outcome between groups (RR 0.98, 95% CI 0.76-1.27, p=0.99; I 2 =43.4%). 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; I 2 =0%). Non-major bleeding was significantly reduced with LAAO (RR 0.50, 95% CI 0.43-0.58, p=0.002; I 2 =0%) with no statistical difference in the major bleeding outcome (RR 0.92, 95% CI 0.73-1.16, p=0.38; I 2 =0%). We found no significant difference between groups in terms of all-cause mortality (RR 1.03, 95% CI 0.87-1.22, p=0.65; I 2 =0%), or systemic embolism (RR 1.29, 95% CI 0.41-4.07, p=0.65; I 2 =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. Additionally, groups were comparable in terms of composite outcomes, all-cause mortality, and systemic embolism. Our findings support an 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 (LAAO) vs. Oral anticoagulation (OAC) was evaluated on Composite of all-cause mortality, stroke, systemic embolism, and major bleeding (RR 0.98, 95% CI 0.76-1.27, p=0.99). Left atrial appendage occlusion showed no significant difference vs oral anticoagulation in composite mortality, stroke, systemic embolism, and major bleeding.
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