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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Left Atrial Appendage Closure Versus Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and

Chen Wang1,2,3, Dan Zhu1,2,3, Jinliang Nan1,2,3

  • 1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.

Journal of Cardiovascular Development and Disease
|December 24, 2025
PubMed

Insights

Left atrial appendage (LAA) closure is a safe and effective alternative to oral anticoagulants for stroke prevention in atrial fibrillation (AF) patients. This procedure significantly reduces mortality and composite endpoints without increasing stroke or bleeding risks.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Atrial fibrillation (AF) necessitates stroke prevention, with oral anticoagulants (OAC) as standard therapy.
  • Left atrial appendage (LAA) closure offers an alternative to OAC, but comparative efficacy and safety data require systematic evaluation.

Purpose of the Study:

  • To systematically evaluate the comparative efficacy and safety of LAA closure versus OAC for stroke prevention in AF patients.
  • To synthesize evidence from randomized controlled trials (RCTs) and propensity score-matched (PSM) studies.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, EmBase, Cochrane Library, Web of Science).
  • Included studies comprised RCTs and PSM studies published up to September 2025.
  • Meta-analysis using a random-effects model estimated treatment effects (Relative Risks with 95% Confidence Intervals).

Main Results:

  • Fifteen studies involving 17,116 AF patients were analyzed.
  • LAA closure significantly reduced the composite endpoint (RR: 0.79; 95% CI: 0.66-0.95) and all-cause mortality (RR: 0.58; 95% CI: 0.49-0.69).
  • No significant differences were observed in risks of stroke (any, ischemic, hemorrhagic) or major bleeding between LAA closure and OAC.

Conclusions:

  • LAA closure demonstrates significant reductions in mortality and composite clinical endpoints compared to OAC in AF patients.
  • The risks of stroke and major bleeding are comparable between LAA closure and OAC.
  • LAA closure is a favorable alternative for AF patients unsuitable for long-term anticoagulation.
Abstract

Keywords:
atrial fibrillationleft atrial appendage closuremeta-analysisoral anticoagulantssystematic review

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