Related Experiment Video

Updated: Jun 19, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Left Atrial Appendage Closure vs Direct Oral Anticoagulants in Atrial Fibrillation: Meta-Analysis of Randomized

Yi-Hsin Chan1, Wen-Han Cheng2, Yung-Hsin Yeh1

  • 1The Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan; Microscopy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

JACC. Advances
|June 17, 2026
PubMed

Insights

Left atrial appendage closure (LAAC) offers reduced bleeding compared to direct oral anticoagulants (DOACs) for atrial fibrillation patients. However, LAAC may increase ischemic stroke risk, though major bleeding and intracranial hemorrhage risks remain similar.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.
  • Direct oral anticoagulants (DOACs) are standard therapy, but bleeding risks necessitate alternative strategies.

Purpose of the Study:

  • To conduct an updated meta-analysis of randomized controlled trials (RCTs) comparing LAAC with DOACs.
  • To evaluate the efficacy and safety of LAAC versus DOACs for stroke prevention in atrial fibrillation.

Main Methods:

  • Systematic search of RCTs comparing percutaneous LAAC with DOACs in atrial fibrillation patients from January 2012 to April 2026.
  • Pooled relative risks (RRs) for efficacy and bleeding outcomes (stroke, death, intracranial hemorrhage) using random-effects models based on longest available follow-up.

Main Results:

  • Four RCTs with 5,890 patients (2,949 LAAC, 2,941 DOACs) were analyzed with median follow-up of 36-42 months.
  • No significant differences observed in all stroke, hemorrhagic stroke, systemic embolism, all-cause death, or cardiovascular death.
  • LAAC significantly reduced nonmajor bleeding and nonprocedure-related major/nonmajor bleeding, but showed a trend towards increased ischemic stroke risk (significant after excluding one trial). Major bleeding and intracranial hemorrhage risks were similar.

Conclusions:

  • LAAC demonstrates a significant reduction in nonmajor and nonprocedure-related bleeding compared to DOACs.
  • The potential increase in ischemic stroke risk with LAAC warrants consideration.
  • LAAC appears comparable to DOACs regarding major bleeding and intracranial hemorrhage risk.
Abstract

Keywords:
atrial fibrillationbleedingdirect oral anticoagulantsleft atrial appendage closurestroke

More Related Videos

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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...
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...