Percutaneous left atrial appendage occlusion versus oral anticoagulation in patients with atrial fibrillation: a systematic review and meta-analysis
In brief
Left atrial appendage occlusion reduces nonprocedural bleeding 44%, not overall bleeding
Across seven randomized trials involving 7,353 people with atrial fibrillation, appendage occlusion and oral anticoagulants had similar rates of death, stroke, and any bleeding. Occlusion reduced bleeding not related to a procedure by 44%, but ischemic stroke was numerically more frequent; whether that signal is real, and how treatment choice affects outcomes, needs further study.
- Journal
- Revista espanola de cardiologia (English ed.) (Q1)
- Published
- 30 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Maddalena Immobile Molaro, Cajetan Reichardt, Fiorenzo Simonetti, Doruntina Lahu, Gjin Ndrepepa, Tobias Lenz, et al.
- PMID
- 42815712
- DOI
- 10.1016/j.rec.2026.09.001
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 1 October 2026).
Abstract
INTRODUCTION AND OBJECTIVES: Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative to oral anticoagulants (OACs) in patients with atrial fibrillation (AF). However, up-to-date comparisons are lacking. We performed a systematic review and meta-analysis of randomized clinical trials comparing percutaneous LAAO with OACs (either a vitamin K antagonist or a direct oral anticoagulant) in patients with AF. METHODS: MEDLINE and EMBASE were searched from inception through March 29, 2026. The primary outcome was all-cause death. Coprimary outcomes were stroke and any bleeding. Secondary outcomes included a composite of ischemic events, systemic embolism, cardiovascular death, ischemic stroke, hemorrhagic stroke, and nonprocedural bleeding. Random-effects meta-analyses were performed using IRRs with 95%CIs. Subgroup and meta-regression analyses were conducted. RESULTS: Seven randomized trials including 7353 patients were analyzed. There were no significant differences between LAAO and OAC in terms of all-cause death (IRR, 0.95; 95%CI, 0.81-1.10), stroke (IRR, 1.00; 95%CI, 0.72-1.39), or any bleeding (IRR, 0.84; 95%CI, 0.64-1.08). LAAO reduced nonprocedural bleeding (IRR, 0.56; 95%CI, 0.45-0.71), but was associated with a numerically higher risk of ischemic stroke (IRR, 1.28; 95%CI, 1.00-1.66). There was a significant interaction between LAAO and the type of OAC regimen in terms of all-cause death (Pinteraction = .02). CONCLUSIONS: In patients with AF eligible for OACs, there were no significant differences in clinical efficacy between LAAO and OAC, whereas LAAO was associated with a significant reduction in nonprocedural bleeding events. The observed trend toward an increased risk of ischemic stroke requires further investigation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.