Arrhythmias & electrophysiology
Left Atrial Appendage Closure vs Direct Oral Anticoagulants in Atrial Fibrillation
- updated meta-analysis of randomized controlled trials
- random-effects models
- longest available follow-up from each trial
+2 more
- random-effects models
- longest available follow-up from each trial
Authors' conclusion
Compared with DOACs, LAAC reduced nonprocedure-related major and nonmajor bleeding, potentially at the cost of an increased risk of ischemic stroke, without significant differences in major bleeding or ICH.
Study context
- Population
- Patients with atrial fibrillation in randomized controlled trials comparing percutaneous left atrial appendage closure (LAAC) with direct oral anticoagulants (DOACs)LAAC 2,949 · DOAC therapy 2,941
- Participants
- 5,890 Four randomized trials
- Comparison
- LAAC vs DOACs
- LAACn = 2,949
- DOACn = 2,941reference
Pooled result
As reported in the abstract
All stroke, hemorrhagic stroke, systemic embolism, all-cause death, cardiovascular death · median follow-up ranged from 36 to 42 months
- No significant differences
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Ischemic stroke — LAAC vs DOAC · numerically higher risk with LAAC | 1.36 (0.99–1.89) | P = 0.06 | |
| Ischemic stroke — LAAC vs DOAC · after exclusion of the OPTION trial | 1.45 (1.03–2.06) | P = 0.03 | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Bleeding — LAAC vs DOAC · all nonmajor | 0.53 (0.40–0.71) | P < 0.0001 | |
| Bleeding — LAAC vs DOAC · nonprocedure-related major | 0.79 (0.65–0.97) | P = 0.02 | |
| Bleeding — LAAC vs DOAC · all nonmajor bleeding | 0.47 (0.39–0.57) | P < 0.0001 | |
| Bleeding — LAAC vs DOAC · all major bleeding | 0.97 (0.81–1.17) | P = 0.77 | |
| Bleeding — LAAC vs DOAC · ICH | 0.76 (0.45–1.26) | P = 0.28 | |
| 0.20.5125Relative risk (log scale) |
Original publication
Left Atrial Appendage Closure vs Direct Oral Anticoagulants in Atrial Fibrillation. JACC Adv. Published 17 June 2026. doi:10.1016/j.jacadv.2026.102933
Summarised from the published abstract; every number is checked against it