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. 2025 Jun 23.
doi: 10.1007/s00392-025-02697-2. Online ahead of print.

Comparison of left atrial appendage occlusion with medical treatment for non-valvular atrial fibrillation: systematic review, network and reconstructed individual patient data meta-analysis

Tsahi T Lerman  1   2 , Roy Hershenson  3   4 , Noam Greenberg  4   5 , Mark Kheifets  3   4 , Yeela Talmor-Barkan  3   4 , Pablo Codner  3   4 , Leor Perl  3   4 , Guy Witberg  3   4 , Aviad Rotholz  3   4 , Shelly Vons  3   4 , Katia Orvin  3   4 , Alon Eisen  3   4 , David Belkin  4 , Boris Fishman  4   6 , Gregory Golovchiner  3   4 , Ran Kornowski  3   4 , Amos Levi  3   4
Affiliations

Comparison of left atrial appendage occlusion with medical treatment for non-valvular atrial fibrillation: systematic review, network and reconstructed individual patient data meta-analysis

Tsahi T Lerman et al. Clin Res Cardiol. .

Abstract

Background: Percutaneous left atrial appendage occlusion (LAAO) is a non-pharmacological strategy to prevent stroke and systemic emboli in patients with non-valvular atrial fibrillation (AF). However, data regarding its safety and efficacy profile compared to different oral anti-coagulant regimens remain limited.

Methods: A network meta-analysis compared LAAO, warfarin, and NOACs (standard dose [SD] and low-dose [LD]). Outcomes included all-cause mortality, stroke or systemic embolism, and bleeding risk. Bayesian models with surface under the cumulative ranking curve (SUCRA) and reconstructed individual patient data (IPD) were utilized.

Results: Twelve studies, including eight randomized controlled trials, were analyzed (13,049 patients with LD NOAC, 29,513 with SD NOAC, 29,611 with warfarin, and 2811 with LAAO). Warfarin was inferior for all-cause mortality compared to LAAO (OR 1.44 [95% CrI; 1.07-1.89]), LD NOAC (OR 1.13 [95% CrI; 1.01-1.26]), and SD NOAC (OR 1.11 [95% CrI; 1.02-1.20]). SUCRA analysis ranked SD NOAC as the most effective for stroke or systemic emboli prevention, LD NOAC as the most effective in preventing major bleeding and LAAO in preventing hemorrhagic stroke.

Conclusions: SD NOACs were the most effective for preventing stroke or systemic embolism, while LD NOACs were the safest in terms of major bleeding. LAAO was comparable to NOACs and superior to warfarin in both safety and efficacy. Further studies are needed to clarify LAAO's role in the management of atrial fibrillation.

Keywords: Atrial fibrillation; Left atrial appendage occlusion; Major bleeding; Non-vitamin K oral anticoagulants; Stroke prevention.

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Conflict of interest statement

Declarations. Conflict of interest: None declared.

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