Left atrial appendage occlusion significantly reduced the risk of all-cause mortality (RR 0.27) compared to NOAC therapy in patients with atrial fibrillation, with no statistical difference in thromboembolic events.
Cohort (n=108,697)
Yes
Does left atrial appendage occlusion reduce all-cause mortality and thromboembolic events compared to non-vitamin K antagonist oral anticoagulant therapy in patients with atrial fibrillation?
In a large real-world propensity-matched cohort, LAA occlusion was associated with significantly lower all-cause mortality compared to NOAC therapy at 2 years, with comparable rates of thromboembolic and bleeding events.
Relative Risk: 0.27 (95% CI 0.14–0.54)
Absolute Event Rate: 1.51% vs 5.6%
Absolute Risk Reduction: 4.09%
p-value: p=<0.001
BACKGROUND: The effects of left atrial appendage (LAA) occlusion compared to non-vitamin K antagonist oral anticoagulant (NOAC) therapy in patients with atrial fibrillation (AF) remain unknown. AIMS: We aimed to evaluate the outcomes in patients with AF who received LAA occlusion vs. NOAC therapy. METHODS: We utilised data from TriNetX which is a global federated health research network currently containing data for 88.5 million patients. ICD-10 codes were employed to identify AF patients treated with either LAA occlusion or NOAC between 1st December 2010 and 17th January 2019. Clinical outcomes of interest were analysed up to 2 years. RESULTS: 108,697 patients were included. Patients who underwent LAA occlusion were younger, more likely to be white Caucasian and male, had a greater incidence of comorbidities, and were less likely to be prescribed other cardiovascular medications. Using propensity score matching, the risk of all-cause mortality was significantly lower among patients who received LAA occlusion compared to NOAC therapy 1.51% vs. 5.60%, RR 0.27 (95% CI 0.14-0.54), but there were no statistical differences in the composite thrombotic or thromboembolic events 8.17% vs. 7.72%, RR 1.06 (95% CI 0.73-1.53), ischaemic stroke or TIA 4.69% vs. 5.45%, RR 0.86 (95% CI 0.54-1.38), venous thromboembolism 1.66% vs. 1.51%, RR 1.10 (95% CI 0.47-2.57) and intracranial haemorrhage 1.51% vs. 1.51%, RR 1.00 (95% CI 0.42-2.39). CONCLUSION: Overall, LAA occlusion might be a suitable alternative to NOAC therapy for stroke prevention in patients with AF.
Ding et al. (Fri,) conducted a cohort in Atrial fibrillation (n=108,697). Left atrial appendage occlusion vs. Non-vitamin K antagonist oral anticoagulants (NOAC) was evaluated on All-cause mortality (RR 0.27, 95% CI 0.14-0.54, p=<0.001). Left atrial appendage occlusion significantly reduced the risk of all-cause mortality (RR 0.27) compared to NOAC therapy in patients with atrial fibrillation, with no statistical difference in thromboembolic events.