Arrhythmias & electrophysiologyMeta-analysis
Catheter-Based Left Atrial Appendage Closure vs Oral Anticoagulation in Patients With Atrial Fibrillation
- Systematic review and meta-analysis of randomised trials
- random-effect model
Authors' conclusion
In patients with AF, at long-term follow-up, transcatheter LAAC was associated with similar rates of any type of stroke and major bleeding compared with OAC, while increasing the risk of ischemic stroke and lowering the risk of nonprocedure-related major bleeding.
Study context
- Population
- Patients with atrial fibrillation (AF) at high risk of stroke
- Participants
- 7,434 patients · 8 RCTs
- Comparison
- Catheter-based left atrial appendage closure (LAAC) vs oral anticoagulation (OAC)
- Outcome
- Stroke and major bleeding (coprimary)
- Follow-up
- Long-term; weighted mean 37.9 months
Pooled result
As reported in the abstract
Stroke and major bleeding (primary and coprimary) · weighted mean follow-up 37.9 months
Stroke: no significant difference, IRR
1.08 (95% CI 0.82-1.41)
Major bleeding: no significant difference, IRR
0.96 (95% CI 0.81-1.14)
Further pooled results
| Outcome | IRR (95% CI) | |
|---|---|---|
| Ischemic stroke | 1.34 (1.01–1.77) | |
| Nonprocedural major bleeding | 0.73 (0.58–0.92) | |
| 0.512Incidence rate ratio (log scale) |
Safety
Periprocedural events per 1000 patients (LAAC procedure)
- Strokes per 1000 patients
- 5
- Episodes of bleeding per 1000 patients
- 9
- Deaths per 1000 patients
- 1
- Episodes of device embolization per 1000 patients
- 5
- Pericardial effusions per 1000 patients
- 9
Original publication
Catheter-Based Left Atrial Appendage Closure vs Oral Anticoagulation in Patients With Atrial Fibrillation. JAMA Cardiol. Published 26 August 2026. doi:10.1001/jamacardio.2026.2640
Summarised from the published abstract; every number is checked against it