Arrhythmias & electrophysiology
Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation
Authors' conclusion
Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation.
Study context
- Population
- Patients with non-valvular atrial fibrillation (NVAF) at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHA2DS2-VASc 4.5 ± 1.6, HAS-BLED 3.8 ± 1.1)
- Participants
- 110 patients · 2 centres
- Comparison
- Left atrial appendage closure (LAAC) (Watchman) vs warfarin, dabigatran, rivaroxaban, apixaban, aspirin and no treatment
- Registry LAACn = 110
- Outcome
- Annual event rates in registry LAAC
- Follow-up
- 24.1 ± 4.6 months
Methodological detailstwo centres, 10-year horizon, sensitivity analyses
- Two centres
- 10-year horizon
- Sensitivity analyses
Pooled result
As reported in the abstract
Mean absolute difference
0.89%
P = 0.02
stroke, lower in registry
Mean absolute difference
5.48%
P < 0.001
major bleeding, lower in registry
- Annual stroke rate
- 0.9% (2/223 patient-years)
- Annual major bleeding rate
- 0.9% (2/223 patient-years)
- Annual all-cause mortality
- 1.8% (4/223 patient-years)
Further pooled results
Procedural success
- Procedural success rate
- 92% (103/112)
Anticoagulant therapy stopped in implanted patients · 12 months
- Anticoagulant therapy successfully stopped
- 91.2% (93/102)
Costs (10-year horizon)
- Cost parity vs dabigatran 110 mg
- 4.9 years
- Cost parity vs warfarin
- 8.4 years
- LAAC cost-saving against all therapies at 10 years
- £1162-£7194
Original publication
Summarised from the published abstract; every number is checked against it