{
  "abstract": "Background\n\nPercutaneous left atrial appendage occlusion (LAAO) is an established alternative to oral anticoagulation (OAC). However, its safety and efficacy boundaries remain incompletely defined in dedicated comparisons against direct oral anticoagulants (DOACs).Objective\n\nThis study applied a pragmatic framework to evaluate the comparative efficacy and safety of LAAO versus OAC in a DOAC-predominant setting.Methods\n\nPubMed, Embase, and Cochrane Library were searched for randomized controlled trials comparing LAAO with OAC, restricted to a DOAC-predominant comparator. Risk ratios (RR) with 95% confidence intervals (CI) were calculated via a Mantel-Haenszel random-effects model.Results\n\nFour trials comprising 5890 patients were included (96.4% of controls assigned to DOACs). Overall stroke (RR 1.18, 95% CI 0.87-1.60; p = 0.28), systemic embolism (RR 1.09, 95% CI 0.29-4.08; p = 0.89), major bleeding (RR 0.98, 95% CI 0.81-1.19; p = 0.85), hemorrhagic stroke (RR 0.82, 95% CI 0.45-1.51; p = 0.53), and all-cause mortality (RR 1.00, 95% CI 0.85-1.17; p = 0.99) did not differ significantly. Ischemic stroke presented numerical asymmetry favoring OAC that approached statistical significance (RR 1.36, 95% CI 0.99-1.89; p = 0.06). Conversely, within available protocol-defined datasets, LAAO significantly reduced nonprocedural clinically relevant bleeding (RR 0.50, 95% CI 0.43-0.60; p < 0.01).Conclusions\n\nIn a pragmatic analysis of the DOAC era, randomized data show no statistically significant differences for hard individual endpoints, though broad confidence intervals reflect precision limits. A numerical asymmetry for ischemic stroke favored OAC, while LAAO reduced nonprocedural clinically relevant bleeding. Current evidence remains non-definitive, warranting shared clinical decision-making to balance individual thromboembolic risks against long-term bleeding susceptibility.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), 2190 Nossa Senhora da Penha Avenue, Vitória, Brazil.",
    "Department of Medicine, Hospital Regional Hans Dieter Schimidt, 330 Xavier Arp Street, Joinville, Brazil.",
    "Hospitalist Department, Cape Fear Valley Health, 1638 Owen Drive, Fayetteville, NC, USA.",
    "Department of Medicine, Universidade Federal de Lavras, Trevo Rotatório Professor Edmir Sá Santos, Lavras, Brazil.",
    "Department of Medicine, Universidade Nove de Julho, 90 Dom Jaime de Barros Câmara Avenue, São Bernardo do Campo, Brazil.",
    "Department of Cardiac Arrhythmias, Centrocor, 60 Alfeu Alves Pereira Street, Vitória, Brazil.",
    "Department of Cardiac Arrhythmias, Vitória Apart Hospital, 591 Governador Mario Covas, Serra, Brazil.",
    "Department of Electrophysiology, Hospital Universitário Cassiano Antonio Moraes (HUCAM), Universidade Federal do Espírito Santo (UFES), 1355 Marechal Campos Avenue, Vitória, Brazil."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Gabriel Moraes Kuniyoshi"
    },
    {
      "affs": [
        1
      ],
      "name": "Rafael Zoppi Campane"
    },
    {
      "affs": [
        2
      ],
      "name": "Nikita Patil"
    },
    {
      "affs": [
        3
      ],
      "name": "Ana Clara Vitorino de Oliveira"
    },
    {
      "affs": [
        4
      ],
      "name": "Beatriz Araújo"
    },
    {
      "affs": [
        5,
        6,
        7
      ],
      "name": "Ricardo Ryoshim Kuniyoshi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fq233b7bn6ztn.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ahjo.2026.100942",
  "fulltext_url": "https://europepmc.org/articles/PMC13677423",
  "id": "fq233b7bn6ztn",
  "issns": [
    "2666-6022"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898218",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7220839443",
  "pdf_url": "https://europepmc.org/articles/PMC13677423?pdf=render",
  "pmcid": "PMC13677423",
  "pmid": "42898218",
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fq233b7bn6ztn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "MED:42898218",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898218"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Percutaneous left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: A pragmatic meta-analysis of randomized trials within the DOAC era.",
  "title_text": "Percutaneous left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: A pragmatic meta-analysis of randomized trials within the DOAC era.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/fq233b7bn6ztn",
  "venue": "American heart journal plus : cardiology research and practice",
  "versions": []
}