Arrhythmias & electrophysiologyMeta-analysis
Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation
- network meta-analyses
- randomized controlled trials
- indirect comparisons
- MEDLINE and CENTRAL
Authors' conclusion
LAAO devices did not demonstrate statistical superiority over DOACs in reducing thromboembolic events and major bleeding. Further trials are warranted to define patients for whom LAAO may offer the most significant benefit, such as those with high bleeding risk (CRD420251237886).
Study context
- Population
- Patients with atrial fibrillationpatients from 11 randomized controlled trials, of whom 5,735 underwent left atrial appendage occlusion (LAAO)
- Participants
- 67,693 patients
- Comparison
- LAAO vs DOAC
- LAAOn = 5,735
- Outcome
- Composite of:
- Stroke
- Systemic embolism
- Cardiovascular death
Pooled result
As reported in the abstract
Hazard ratio
1.02
95% CI 0.88–1.19
LAAO vs DOACs
HR 1.02 (95% CI 0.88–1.19)
Further pooled results
Primary outcome and major bleeding, 4-arm network meta-analysis
- Amulet and Watchman associated with similar risks of the primary outcome, comparable to those of direct oral anticoagulants (DOACs), as well as the risk of major bleeding
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding · I2 = 70.5%; three-arm network meta-analysis · statistically similar risks | 0.98 (0.78–1.23) | |
| 0.512Hazard ratio (log scale) |
Original publication
Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation. JACC Adv. Published 23 September 2026. doi:10.1016/j.jacadv.2026.103269
Summarised from the published abstract; every number is checked against it