Left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials
Abstract
Background: Data comparing left atrial appendage occlusion (LAAO) with contemporary oral anticoagulation (OAC) remain uncertain, particularly in the era of safer and more effective direct oral anticoagulants. We investigated the comparative safety and efficacy of LAAO and OAC in patients with atrial fibrillation.
Methods: We conducted a systematic literature search of MEDLINE, EMBASE, and Cochrane from January 2000 to April 2026, to identify eligible randomized controlled trials comparing LAAO to OAC in patients with atrial fibrillation. The primary outcome was all-cause mortality. Secondary outcomes were ischemic stroke, major and non-major bleeding, and systemic embolism. Pooled effect sizes were calculated using fixed or random effects models and expressed as risk ratios (RR) or mean difference (MD) with 95% confidence intervals.
Results: Six RCTs comprising 7004 patients (LAAO: 3681; OAC: 3323) were included. There was no statistically significant difference in all-cause mortality between groups (RR 1.03, 95% CI 0.87-1.22, p = 0.65; I²=0.0%). LAAO was associated with a significantly higher risk of ischemic stroke compared to OAC (RR 1.32, 95% CI 1.04-1.68, p = 0.03; I²=0%). Non-major bleeding was significantly reduced with LAAO (RR 0.50, 95% CI 0.43-0.58, p = 0.002; I²=0%) with no statistical difference in the major bleeding outcome (RR 0.92, 95% CI 0.73-1.16, p = 0.38; I²=0%). We found no significant difference between groups in terms of systemic embolism (RR 1.29, 95% CI 0.41-4.07, p = 0.60; I²=0%).
Conclusions: LAAO was associated with a significantly higher ischemic stroke risk, while reducing non-major bleeding, however with no significant reduction in the major bleeding outcome overall. Additionally, groups were comparable in terms of all-cause mortality, and systemic embolism. These findings support a cautious, individualized approach to LAAO adoption in clinical practice.
Related
- Percutaneous left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: A pragmatic meta-analysis of randomized trials within the DOAC era.
- Left atrial appendage occlusion: an alternative to anticoagulation in atrial fibrillation
- Percutaneous Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Bayesian Meta-analysis
- Left Atrial Appendage Occlusion versus Oral Anticoagulation in Atrial Fibrillation
- Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion
BibTeX
@article{gonnah2026left,
title = {{Left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials}},
author = {Ahmed R Gonnah and Ahmed K. Awad and Adel Mouffokes and AlMothana Manasrah and Ahmed Sayed and Lyndsey Della Vecchia and Omar Shazly and C. Michael Gibson and David H. Roberts and Gregory Y.H. Lip},
journal = {BMC Medicine},
year = {2026},
month = oct,
doi = {10.1186/s12916-026-05285-x},
url = {https://link.springer.com/article/10.1186/s12916-026-05285-x},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials
AU - Ahmed R Gonnah
AU - Ahmed K. Awad
AU - Adel Mouffokes
AU - AlMothana Manasrah
AU - Ahmed Sayed
AU - Lyndsey Della Vecchia
AU - Omar Shazly
AU - C. Michael Gibson
AU - David H. Roberts
AU - Gregory Y.H. Lip
PY - 2026
DA - 2026/10/14
JO - BMC Medicine
DO - 10.1186/s12916-026-05285-x
UR - https://link.springer.com/article/10.1186/s12916-026-05285-x
AB - Background: Data comparing left atrial appendage occlusion (LAAO) with contemporary oral anticoagulation (OAC) remain uncertain, particularly in the era of safer and more effective direct oral anticoagulants. We investigated the comparative safety and efficacy of LAAO and OAC in patients with atrial fibrillation. Methods: We conducted a systematic literature search of MEDLINE, EMBASE, and Cochrane from January 2000 to April 2026, to identify eligible randomized controlled trials comparing LAAO to OAC in patients with atrial fibrillation. The primary outcome was all-cause mortality. Secondary outcomes were ischemic stroke, major and non-major bleeding, and systemic embolism. Pooled effect sizes were calculated using fixed or random effects models and expressed as risk ratios (RR) or mean difference (MD) with 95% confidence intervals. Results: Six RCTs comprising 7004 patients (LAAO: 3681; OAC: 3323) were included. There was no statistically significant difference in all-cause mortality between groups (RR 1.03, 95% CI 0.87-1.22, p = 0.65; I²=0.0%). LAAO was associated with a significantly higher risk of ischemic stroke compared to OAC (RR 1.32, 95% CI 1.04-1.68, p = 0.03; I²=0%). Non-major bleeding was significantly reduced with LAAO (RR 0.50, 95% CI 0.43-0.58, p = 0.002; I²=0%) with no statistical difference in the major bleeding outcome (RR 0.92, 95% CI 0.73-1.16, p = 0.38; I²=0%). We found no significant difference between groups in terms of systemic embolism (RR 1.29, 95% CI 0.41-4.07, p = 0.60; I²=0%). Conclusions: LAAO was associated with a significantly higher ischemic stroke risk, while reducing non-major bleeding, however with no significant reduction in the major bleeding outcome overall. Additionally, groups were comparable in terms of all-cause mortality, and systemic embolism. These findings support a cautious, individualized approach to LAAO adoption in clinical practice.
SN - 1741-7015
ER -