Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in

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Aminah Abdul Razzack1, Hassan Mehmood Lak2, Greeshma Erasani1

  • 1Department of Internal Medicine, Dr. N.T.R University of Health Sciences, 520008 Vijayawada, India.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed

Insights

Direct oral anticoagulants (DOACs) and Left Atrial Appendage Occlusion (LAAO) show comparable long-term efficacy and safety for stroke prevention in atrial fibrillation (AF) patients. Both treatments offer similar outcomes regarding cardiovascular mortality and bleeding events.

Area of Science:

  • Cardiology
  • Medical Devices
  • Pharmacology

Background:

  • Atrial fibrillation (AF) necessitates anticoagulation for stroke prevention, with direct oral anticoagulants (DOACs) often preferred over warfarin.
  • The long-term efficacy and safety comparison between DOACs and Left Atrial Appendage Occlusion (LAAO) in AF patients requires further investigation.

Purpose of the Study:

  • To compare the long-term efficacy and safety of DOACs versus LAAO for stroke prevention in patients with Atrial Fibrillation.
  • To evaluate cardiovascular mortality, ischemic stroke/TIA, systemic embolism, and clinically relevant bleeding between the two treatment groups.

Main Methods:

  • A systematic review and meta-analysis of studies comparing DOACs and LAAO was conducted.
  • Searches were performed on PubMed, Embase, and Scopus databases up to February 10th, 2021.
  • Primary endpoint was cardiovascular mortality; secondary endpoints included ischemic stroke/TIA, systemic embolism, and clinically relevant bleeding.

Main Results:

  • Three studies with 3039 participants (1465 LAAO, 1574 DOACs) were included, with a mean follow-up of 2 years.
  • No significant differences were observed in cardiovascular mortality (RR 0.90, 95% CI 0.40-2.03), ischemic stroke/TIA (RR 1.15, 95% CI 0.80-1.65), or clinically significant bleeding (RR 0.77, 95% CI 0.50-1.17) between LAAO and DOACs.
  • The average age of participants was approximately 74-75 years.

Conclusions:

  • Left Atrial Appendage Occlusion (LAAO) is comparable to direct oral anticoagulants (DOACs) in managing stroke risk for patients with Atrial Fibrillation.
  • Both LAAO and DOACs demonstrate similar long-term efficacy and safety profiles in this patient population.
  • The findings support LAAO as a viable alternative to DOACs for stroke prevention in AF.
Abstract

Keywords:
atrial fibrillationbleedingdirect oral anticoagulationischemic strokeleft atrial appendage occlusion

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