{
  "abstract": "Background: Emergence of direct oral anticoagulants as the first-line therapy for stroke prevention in nonvalvular atrial fibrillation has redefined the comparator benchmark for left atrial appendage occlusion (LAAO). Objectives: The objective of the study was to compare the efficacy and temporal safety of LAAO vs oral anticoagulation (OAC). Methods: Randomized trials of LAAO vs OAC in nonvalvular atrial fibrillation were pooled for incidence rate ratios (IRRs) per patient-year; key endpoints were assessed with trial sequential analysis (TSA) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Across 6 trials (N = 7,004), LAAO vs OAC was associated with higher ischemic stroke (130 vs 76 events; IRR: 1.43; 95% CI: 1.07-1.91; P = 0.01; number needed to harm: 101; GRADE: low); however, this was sensitive to individual trial exclusion and TSA indicated insufficient information (41% of required size). All-cause stroke (152 vs 114; IRR: 1.11; 95% CI: 0.86-1.43; P = 0.43) and all-cause mortality (403 vs 368; IRR: 0.93; 95% CI: 0.78-1.10; P = 0.39) were comparable. Total major bleeding did not differ (IRR: 0.91; P = 0.29), but LAAO significantly reduced nonprocedural major bleeding (194 vs 232; IRR: 0.71; 95% CI: 0.55-0.91; P = 0.01; number needed to treat: 19; GRADE: high) and clinically relevant nonmajor bleeding (145 vs 303; IRR: 0.48; 95% CI: 0.39-0.58; P < 0.001; number needed to treat: 15). Conclusions: LAAO significantly reduces nonprocedural major bleeding (TSA-confirmed) and clinically relevant nonmajor bleeding vs OAC. A trend toward higher ischemic stroke was not TSA-confirmed and was sensitive to trial exclusion; all-cause stroke and mortality were similar. These findings quantify the benefit–harm tradeoff central to LAAO decisions.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiovascular Medicine, State University of New York, Downstate Health Sciences, Brooklyn, New York, New York, USA",
    "Section of Vascular Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA",
    "Department of Internal Medicine, Riverside Regional Medical Center, Virginia, USA",
    "Section of Electrophysiology, Department of Cardiovascular Medicine, Robert Wood Johnson University, New Jersey, USA",
    "Section of Electrophysiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA",
    "Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Aravind Dilli Babu, MD"
    },
    {
      "affs": [
        1
      ],
      "name": "Scott J. Cameron, MD, PhD"
    },
    {
      "affs": [
        2
      ],
      "name": "Haroon Gill, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Asher Gorantla, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Karan Bhanushali, MD"
    },
    {
      "affs": [
        3
      ],
      "name": "Subhashini Gowda, MD"
    },
    {
      "affs": [
        4
      ],
      "name": "Mohamed Kanj, MD"
    },
    {
      "affs": [
        5
      ],
      "name": "Grant W. Reed, MD"
    },
    {
      "affs": [
        5
      ],
      "name": "Amar Krishnaswamy, MD"
    },
    {
      "affs": [
        5
      ],
      "name": "Samir Kapadia, MD"
    },
    {
      "affs": [
        5
      ],
      "name": "Aravinda Nanjundappa, MD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a9rzrqawj7y7f.bib",
  "cited_by": 1,
  "doi": "10.1016/j.jacadv.2026.103251",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2772963X26006721",
  "id": "a9rzrqawj7y7f",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://doi.org/10.1016/j.jacadv.2026.103251",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC666-701"
    ],
    [
      "lcc",
      "RC86-88.9"
    ],
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      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
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  "pdf_url": "https://www.jacc.org/doi/pdf/10.1016/j.jacadv.2026.103251?download=true",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/a9rzrqawj7y7f.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T14:22:44Z",
      "native_id": "06c22c7e91604e3f80d546f4a9805cb5",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
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  ],
  "title": "Left Atrial Appendage Occlusion versus Oral Anticoagulation in Atrial Fibrillation",
  "title_text": "Left Atrial Appendage Occlusion versus Oral Anticoagulation in Atrial Fibrillation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T14:20:43Z",
  "url": "https://research.draconitic.com/paper/a9rzrqawj7y7f",
  "venue": "JACC: Advances",
  "versions": []
}