Journal article
Left Atrial Appendage Closure Versus Oral Anticoagulation in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
Cardiovascular revascularization medicine, Vol.36, pp.18-24
03/2022
DOI: 10.1016/j.carrev.2021.04.019
PMID: 33903038
Abstract
Left atrial appendage closure (LAAC) devices are an alternative therapy in non-valvular atrial fibrillation (NVAF) patients with contraindications to oral anticoagulation (OAC). However, there are limited data about the clinical outcomes of LAAC devices compared to medical treatment.
A comprehensive research for studies comparing LAAC devices and OAC for patients with NVAF was performed from inception to January 1, 2021. A meta-analysis was performed using a random effect model to calculate odds ratios (OR) with 95% confidence intervals (CIs).
Five studies were eligible that included a total of 4778 patients with a median-weighted follow-up period was 2.6 years. Compared to OAC, the LAAC device arm was associated with a lower risk of the composite of stroke, systemic embolism, and cardiovascular death (OR 0.71; 95% CI 0.51–1.00; p = 0.05). LAAC device arm was also associated with a lower risk of all-cause mortality (OR of 0.60, 95% CI 0.46–0.77; p < 0.0001), cardiovascular mortality (OR of 0.57, 95% CI 0.46–0.70; p < 0.00001), hemorrhagic stroke (OR of 0.19, 95% CI 0.07–0.50; p= 0.0006), all major bleeding (OR of 0.61, 95% CI 0.43–0.88; p = 0.007) and non-procedural major bleeding (OR of 0.46, 95% CI 0.32–0.65; p < 0.0001). There was no significant difference in all stroke, ischemic stroke, and systemic embolization between the two groups.
Our meta-analysis showed lower all-cause mortality, cardiovascular mortality, hemorrhagic stroke, major bleeding, non-procedural major bleeding and the composite of stroke, systemic embolism, and cardiovascular death in the LAAC device arm when compared to OAC. However, the risk of all stroke, ischemic stroke, and systemic embolism were similar between the two arms.
•Left atrial appendage closure (LAAC) devices are approved as an alternative therapy in patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation (OAC).•Our pooled analysis showed a lower rate of the composite primary outcome, all-cause mortality, hemorrhagic stroke, and non-procedural major bleeding in the LAAC arm when compared to OAC.•The risk of all stroke, ischemic stroke, systematic embolism, and all major bleeding was similar between the two groups.
Details
- Title: Subtitle
- Left Atrial Appendage Closure Versus Oral Anticoagulation in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
- Creators
- Abdullah Al-abcha - Michigan State UniversityYehia Saleh - Houston MethodistMahmoud Elsayed - Allegheny General HospitalAhmed Elshafie - Michigan State UniversityKhader Herzallah - Tufts Medical CenterZulfiqar Qutrio Baloch - Michigan State UniversitySandeep Banga - Michigan State UniversitySupratik Rayamajhi - Michigan State UniversityGeorge S. Abela - Michigan State University
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.36, pp.18-24
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.carrev.2021.04.019
- PMID
- 33903038
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Number of pages
- 7
- Language
- English
- Date published
- 03/2022
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984756260002771
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