Related Experiment Video
Updated: Sep 13, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: Long-term
Wulamiding Kaisaier1, Zixuan Xu2, Linjuan Guo3
1Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.
Insights
Left atrial appendage closure (LAAC) reduces death and bleeding events compared to oral anticoagulants (OACs) in atrial fibrillation (AF) patients. This analysis suggests LAAC is a safe alternative for stroke prevention in selected AF individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Left atrial appendage closure (LAAC) is an alternative stroke prevention strategy for atrial fibrillation (AF) patients unable to use oral anticoagulants (OACs).
- Long-term comparative effectiveness data between LAAC and OACs in the broader AF population are limited.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of LAAC versus OACs for stroke prevention in patients with AF.
- To conduct a meta-analysis of randomized controlled trials (RCTs) to compare these treatment strategies.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library for relevant RCTs.
- Meta-analysis using fixed-effects models to calculate risk ratios (RRs) and 95% confidence intervals (CIs).
- Inclusion of four RCTs with 3116 AF patients and follow-up up to 49.6 months.
Main Results:
- LAAC demonstrated reduced risks of all-cause death (RR=0.78) and cardiovascular/unexplained death (RR=0.69) compared to OACs.
- Significantly lower risk of hemorrhagic stroke (RR=0.34) and non-procedural bleeding (RR=0.49) with LAAC.
- No significant differences in stroke, ischemic stroke, systemic embolism, or non-cardiovascular death rates; major bleeding risk was similar.
Conclusions:
- LAAC is associated with significantly lower risks of death, hemorrhagic stroke, and non-procedural bleeding compared to OACs.
- LAAC does not increase the risk of thromboembolic events or major bleeding.
- Findings support LAAC as a viable alternative to OACs for stroke prevention in select AF patients.
Background:
Left atrial appendage closure (LAAC) is primarily indicated for stroke prevention in patients with atrial fibrillation (AF) who have contraindications to long-term oral anticoagulants (OACs). However, the long-term comparative benefits of LAAC vs OACs in the broader AF population remain unclear.
Objective:
To study aimed to assess the long-term efficacy and safety of LAAC compared with OACs in patients with AF, we conducted a meta-analysis of randomized controlled trials (RCTs).
Methods:
We systematically searched PubMed, Embase, and Cochrane Library for eligible RCTs. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed-effects models.
Results:
Four RCTs involving 3116 patients with AF (1736 assigned to LAAC and 1380 to OACs) and follow-up durations ranging from 36 to 49.6 months were included. Compared with OACs, LAAC was associated with reduced risks of all-cause death (RR = 0.78; 95% CI: 0.64-0.95) and cardiovascular or unexplained death (RR = 0.69; 95% CI: 0.51-0.94). There were no significant differences between the 2 groups in stroke or systemic embolism, ischemic stroke, or systemic embolism, and non-cardiovascular death. LAAC was associated with significantly lower risk of hemorrhagic stroke (RR = 0.34; 95% CI: 0.16-0.76) and non-procedural clinically relevant bleeding (RR = 0.49; 95% CI: 0.40-0.61). Major bleeding (including procedural and non-procedural) risk did not differ significantly between groups.
Conclusion:
In this meta-analysis of RCTs, LAAC was associated with significantly lower risks of all-cause and cardiovascular death, hemorrhagic stroke, and non-procedural clinically relevant bleeding compared with OACs, without increasing the risk of thromboembolic events or major bleeding. These findings support the consideration of LAAC as an alternative to OAC in selected patients with AF.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...