Arrhythmias & electrophysiologyMeta-analysis
Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- systematic review and meta-analysis of randomized controlled trials
- random-effects model
- in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
Authors' conclusion
In patients with atrial fibrillation, LAAC is associated with a higher risk of ischemic stroke, but lower risk of nonprocedural major bleeding compared with OAC, with no significant differences in composite thromboembolic outcomes or mortality, underscoring the importance of individualized risk-benefit assessment in stroke prevention strategies.
Study context
- Population
- Adults with atrial fibrillation; databases searched from January 2000 to March 2026patients in six randomized controlled trials · left atrial appendage closure (LAAC) 3,681 · oral anticoagulation (OAC) 3,323
- Participants
- 7,004 adults
- Comparison
- LAAC versus OAC
- LAACn = 3,681
- OACn = 3,323reference
- Outcome
- Any stroke (primary efficacy end point)
Pooled result
As reported in the abstract
Relative risk
1.08
95% CI 0.82–1.42
P = 0.60
LAAC vs OAC
RR 1.08 (95% CI 0.82–1.42); P = 0.60
Further pooled results
| Outcome | LAAC | OAC | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Ischemic stroke · higher risk with LAAC | 3.2% | 2.1% | 1.41 (1.04–1.91) | P = 0.03 | |
| Composite of stroke, systemic embolism, or death · no significant difference | 0.99 (0.77–1.29) | P = 0.96 | |||
| 0.512Relative risk (log scale) |
| Outcome | RR | P value |
|---|---|---|
| Cardiovascular mortality · similar between groups | 0.88 | P = 0.40 |
| All-cause mortality · similar between groups | 0.92 | P = 0.36 |
Safety
| Outcome | LAAC | OAC | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Nonprocedural major bleeding · lower risk with LAAC | 6.2% | 10.7% | 0.57 (0.43–0.77) | P < 0.01 | |
| 0.512Relative risk (log scale) |
| Outcome | RR | P value |
|---|---|---|
| Major bleeding, including procedural events (primary safety end point) · did not differ significantly | 0.93 | P = 0.40 |
Original publication
Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol. Published 21 August 2026. doi:10.1161/circep.126.015245
Summarised from the published abstract; every number is checked against it