Associazione Nazionale Medici Cardiologi Ospedalieri



Efficacy and safety of left atrial appendage closure compared with oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials and propensity-matched studies

Piroli Francesco Reggio Emilia (Reggio Emilia) – Ospedale Amsn Reggio Emilia | Franchin Luca Udine (Udine) – Ospedale Santa Maria Della Misericordia | Demola Pierluigi Reggio Emilia (Reggio Emilia) – Ospedale Asmn Reggio Emilia | Navazio Alessandro Reggio Emilia (Reggio Emilia) – Ospedale Asmn Reggio Emilia

Backgrounds. In the recent years, two randomized controlled trials (RCTs), the PROTECT-AF trial and the PREVAIL trial demonstrated that in atrial fibrillation (AF) patients, left atrial appendage closure (LAAC) compared with oral anticoagulants (OAC), showed a non-inferiority in the prevention of stroke and even a reduction in mortality. Nevertheless, this net clinical benefit was not confirmed in the most recent RCT comparing LAAC vs OAC, the PRAGUE-17 trial.

The aim of the present meta-analysis was to evaluate the efficacy and safety of LAAC compared to OAC among available high-quality studies.

Methods. A systematic search of electronic databases (Medline, Scopus, Embase and the Cochrane Library) was performed to identify eligible RCTs and observational studies with propensity score matching (PSM) analysis. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Outcomes of interest were the occurrence of cardiovascular death (CVD), all cause death, all-type stroke, and major bleedings.

Results. A total of 3 RCTs and 6 PMS studies involving 6924 patients were identified. After a median follow-up of 2.7 years (IQR 2-4.5), patients who received LAAC had a lower risk of CVD (OR=0.58; 95%CI 0.48-0.71, I2=0%), all cause death (0.59; 95% CI 0.45-0.76, I2 67%) and major bleedings (OR=0.58; 95%CI 0.43-78 I2=52%) compared with patients on OAC. No difference was found between the two groups regarding strokes incidence (OR=0.94; 95% CI 0.76-1.16, I2=0%).

Conclusions. According to this meta-analysis, LAAC presents a comparable efficacy in the prevention of stroke compared to OAC with a reduced risk of major bleedings, all cause death and CVD that may stand out with longer follow-up.