Arrhythmias & electrophysiologyMeta-analysis
Left Atrial Appendage Closure vs Anticoagulation for Stroke Prevention in Atrial Fibrillation
- meta-analysis of randomized controlled trials
Authors' conclusion
LAAC prevents stroke/SE at rates not significantly different from OAC while reducing clinically significant bleeding, with possibly a more favorable benefit in postablation patients. In the full cohort, the numerically higher ischemic stroke rate was not statistically significant, and small in absolute terms. These findings support LAAC based on individualized, patient-centered decision-making, balancing stroke and bleeding risks.
Study context
- Population
- Patients with atrial fibrillationpatients in seven randomized controlled trials, CHA2DS2-VASc score: 3.9, mean follow-up: 37.6 months
- Participants
- 7,353 patients
- Comparison
- Left atrial appendage closure (LAAC) to oral anticoagulation (OAC)
- Outcome
- stroke or systemic embolism (stroke/SE)
- Follow-up
- Mean : 37.6 months
Pooled result
As reported in the abstract
Relative risk
1.10
95% CI 0.82–1.48
- stroke/SE events
- 294
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Clinically significant bleeding · less frequent after LAAC | 0.60 (0.36–0.98) | |
| Non-procedure-related clinically significant bleeding · less frequent after LAAC | 0.50 (0.39–0.64) | |
| Stroke/SE in postablation patients (subgroup) | 0.92 (0.53–1.60) | |
| Nonprocedural clinically significant bleeding in postablation patients (subgroup) · less with LAAC | 0.51 (0.42–0.62) | |
| 0.20.5125Relative risk (log scale) |
- Stroke/SE in postablation patients (subgroup): P-interaction = 0.76
- Nonprocedural clinically significant bleeding in postablation patients (subgroup): P-interaction = 0.56
Ischemic stroke, hemorrhagic stroke, major bleeding (MB), cardiovascular mortality, all-cause mortality
- No statistically significant differences
Annualized incidence rate difference of stroke with LAAC
- Did not exceed in any nonwarfarin-OAC comparative trial
- 0.37%/year
- Did not increase with higher CHA2DS2-VASc scores
Original publication
Summarised from the published abstract; every number is checked against it