AI Article Synopsis
- Direct Oral Anticoagulants (DOACs) are commonly used for treating non-valvular atrial fibrillation (NVAF), but Percutaneous Left Atrial Appendage Occlusion (LAAO) is a new treatment method with uncertain safety and effectiveness compared to DOACs.
- A systematic review of ten studies involving over 18,500 patients found that LAAO is linked to lower all-cause and cardiovascular mortality rates, as well as a reduction in the composite outcomes of death, bleeding, and thromboembolic events.
- While LAAO showed trends toward reduced stroke or TIA events and lower bleeding rates compared to DOACs, no significant differences in thromboembolic events were observed.
Article Abstract
Background: Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial.
Methods: A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions.
Results: Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events.
Conclusion: LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.
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| http://dx.doi.org/10.1016/j.cpcardiol.2024.102880 | DOI Listing |
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