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. 2023 Feb 2;24(2):44.
doi: 10.31083/j.rcm2402044. eCollection 2023 Feb.

Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Aminah Abdul Razzack  1 , Hassan Mehmood Lak  2 , Greeshma Erasani  1 , Sajedur Rahman  3 , Nabeel Hussain  4 , Bilal Farhat Ali  5 , Srilatha Eapi  6 , Farah Yasmin  7 , Hala Najeeb  7 , Ahmad Mustafa  8 , Sanchit Chawla  2 , Muhammad Bilal Munir  9 , Amr F Barakat  10 , Walid Saliba  11 , Oussama Wazni  11 , Ayman A Hussein  11
Affiliations

Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Aminah Abdul Razzack et al. Rev Cardiovasc Med. .

Abstract

Background: Prevention of stroke by anticoagulation is essential in patients with Atrial fibrillation (AF); with direct oral anticoagulants (DOACs) being preferred over warfarin in most patients. The Long-term efficacy and safety of DOACs vs. Left Atrial Appendage Occlusion (LAAO) remain unknown.

Methods: Electronic databases (PubMed, Embase, Scopus) were searched from inception to February 10th, 2021. The primary endpoint was cardiovascular mortality. Secondary outcomes included incidence of ischemic stroke/transient ischemic attack (TIA) and systemicembolism. The safety endpoint was clinically relevant bleeding (a composite of major or minor clinically relevant bleeding).

Results: A total of three studies with 3039 participants (LAAO = 1465; DOACs = 1574) were included. Mean age was 74.2 and 75.3 years in the LAAO and DOAC group respectively. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.90, 95% CI 0.40-2.03; p = 0.81), ischemic stroke/TIA (RR 1.15, 95% CI 0.80-1.65; p = 0.46; I 2 = 0) and clinically significant bleeding (RR 0.77, 95% CI 0.50-1.17; p = 0.22; I 2 = 69) between the groups.

Conclusions: Among patients with AF, LAAO was comparable to DOACs with similar efficacy and safety profiles.

Keywords: atrial fibrillation; bleeding; direct oral anticoagulation; ischemic stroke; left atrial appendage occlusion.

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Conflict of interest statement

Dr Wazni serves a consultant speaker for Boston Scientific and Biosense Webster. The remaining authors have no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Forrest plot comparing LAAO to DOAC for the primary efficacy endpoint of cardiovascular mortality.
Fig. 2.
Fig. 2.
Forrest plot comparing LAAO to DOAC for the incidence of Ischemicstrokes/TIA.
Fig. 3.
Fig. 3.
Forrest plot comparing LAAO to DOAC for the incidence of systemic embolism.
Fig. 4.
Fig. 4.
Forrest plot comparing LAAO to DOAC for the safety endpoint.
See this image and copyright information in PMC

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