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Outcomes of LAAO vs. DOACs in Obese Patients With Atrial Fibrillation a 5-Year Propensity-Matched Analysis

Mohamad Mdaihly1, Issam Motairek1, Arwa Younis1

  • 1Department of Cardiovascular Medicine, Cleveland Clinic, Cardiac Electrophysiology and Pacing Section, Cleveland, Ohio, USA.

Pacing and Clinical Electrophysiology : PACE
|November 18, 2025
PubMed

Insights

Left appendage atrial occlusion (LAAO) and direct oral anticoagulants (DOACs) show similar stroke and bleeding protection in obese atrial fibrillation (AF) patients. LAAO significantly reduces all-cause mortality over five years in this high-risk group.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Outcomes

Background:

  • Obese patients with atrial fibrillation (AF) face elevated risks of thromboembolic and bleeding events.
  • Direct oral anticoagulants (DOACs) are standard for stroke prevention in AF but carry a significant bleeding risk in obese individuals.
  • Comparative data on left appendage atrial occlusion (LAAO) versus DOACs in this population are limited.

Purpose of the Study:

  • To compare the 5-year clinical outcomes of LAAO versus DOACs in obese patients diagnosed with AF.
  • To evaluate stroke prevention and bleeding risk associated with LAAO and DOACs in high-risk obese AF patients.

Main Methods:

  • Utilized the TriNetX database to identify obese AF patients (BMI ≥40 kg/m²).
  • Established two cohorts: LAAO (n=1571) and DOACs (n=103,047).
  • Applied propensity score matching to create comparable cohorts (n=1566 each) and analyzed outcomes including stroke, hemorrhage, bleeding, MI, and mortality over 5 years.

Main Results:

  • Stroke rates were comparable between LAAO and DOAC groups at 5 years (HR: 1.00; 95% CI: 0.69-1.43).
  • Major bleeding rates were also similar between the LAAO and DOAC cohorts (HR: 0.99; 95% CI: 0.71-1.42).
  • LAAO demonstrated a significant reduction in all-cause mortality compared to DOACs (HR: 0.64; 95% CI: 0.54-0.76; p < 0.001).

Conclusions:

  • LAAO provides comparable stroke and bleeding protection to DOACs in obese AF patients.
  • LAAO is associated with a significant reduction in all-cause mortality over a 5-year period.
  • LAAO emerges as a promising long-term stroke prevention strategy for high-risk obese AF patients.
Abstract

Keywords:
atrial fibrillationdirect oral anticoagulants (DOACS)left atrial appendage occlusion (LAAO)obesitystroke prevention

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