Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: Long-term outcomes from 4 randomized trials

作者：Wulamiding Kaisaier, Zixuan Xu, Linjuan Guo, Yugang Dong, Yili Chen, Gregory Y. H. Lip, Wengen Zhu · 发表于：Heart Rhythm · 年份：2025 · DOI：10.1016/j.hrthm.2025.07.051 · 被引用次数：20 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiovascular Disease and Adiposity、Pericarditis and Cardiac Tamponade

BACKGROUND: Left atrial appendage closure (LAAC) is primarily indicated for stroke prevention in patients with atrial fibrillation (AF) who have contraindications to long-term oral anticoagulants (OACs). However, the long-term comparative benefits of LAAC vs OACs in the broader AF population remain unclear. OBJECTIVE: To study aimed to assess the long-term efficacy and safety of LAAC compared with OACs in patients with AF, we conducted a meta-analysis of randomized controlled trials (RCTs). METHODS: We systematically searched PubMed, Embase, and Cochrane Library for eligible RCTs. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed-effects models. RESULTS: Four RCTs involving 3116 patients with AF (1736 assigned to LAAC and 1380 to OACs) and follow-up durations ranging from 36 to 49.6 months were included. Compared with OACs, LAAC was associated with reduced risks of all-cause death (RR = 0.78; 95% CI: 0.64-0.95) and cardiovascular or unexplained death (RR = 0.69; 95% CI: 0.51-0.94). There were no significant differences between the 2 groups in stroke or systemic embolism, ischemic stroke, or systemic embolism, and non-cardiovascular death. LAAC was associated with significantly lower risk of hemorrhagic stroke (RR = 0.34; 95% CI: 0.16-0.76) and non-procedural clinically relevant bleeding (RR = 0.49; 95% CI: 0.40-0.61). Major bleeding (including procedural and non-procedural) risk did not differ significantly between groups. CONCLUSION: In this m...