Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Aminah Abdul Razzack; Hassan Mehmood Lak; Greeshma Erasani; Sajedur Rahman; Nabeel Hussain; Bilal Farhat Ali; Srilatha Eapi; Farah Yasmin; Hala Najeeb; Ahmad Mustafa; Sanchit Chawla; Muhammad Bilal Munir; Amr F Barakat; Walid Saliba; Oussama Wazni; Ayman A Hussein

doi:10.31083/j.rcm2402044

Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Rev Cardiovasc Med. 2023 Feb 2;24(2):44. doi: 10.31083/j.rcm2402044. eCollection 2023 Feb.

Authors

Aminah Abdul Razzack¹, Hassan Mehmood Lak², Greeshma Erasani¹, Sajedur Rahman³, Nabeel Hussain⁴, Bilal Farhat Ali⁵, Srilatha Eapi⁶, Farah Yasmin⁷, Hala Najeeb⁷, Ahmad Mustafa⁸, Sanchit Chawla², Muhammad Bilal Munir⁹, Amr F Barakat¹⁰, Walid Saliba¹¹, Oussama Wazni¹¹, Ayman A Hussein¹¹

Affiliations

¹ Department of Internal Medicine, Dr. N.T.R University of Health Sciences, 520008 Vijayawada, India.
² Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
³ Department of Internal Medicine, Jalalabad Ragib Rabeya Medical College and Hospital, 3030 Sylhet, Bangladesh.
⁴ Department of Medicine, Saba University School of Medicine, JQG3+87 The Bottom, Netherland Antilles.
⁵ Department of Medicine, Akhtar Saeed Medical and Dental College, 54000 Lahore, Pakistan.
⁶ Department of Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
⁷ Department of Internal Medicine, Dow University of Health Sciences, 74200 Karachi, Pakistan.
⁸ Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA.
⁹ Section of Electrophysiology, Department of Cardiovascular Medicine, University of. California San Diego, San Diego, CA 92111, USA.
¹⁰ Section of Electrophysiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA.
¹¹ Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

Abstract

Background: Prevention of stroke by anticoagulation is essential in patients with Atrial fibrillation (AF); with direct oral anticoagulants (DOACs) being preferred over warfarin in most patients. The Long-term efficacy and safety of DOACs vs. Left Atrial Appendage Occlusion (LAAO) remain unknown.

Methods: Electronic databases (PubMed, Embase, Scopus) were searched from inception to February 10th, 2021. The primary endpoint was cardiovascular mortality. Secondary outcomes included incidence of ischemic stroke/transient ischemic attack (TIA) and systemicembolism. The safety endpoint was clinically relevant bleeding (a composite of major or minor clinically relevant bleeding).

Results: A total of three studies with 3039 participants (LAAO = 1465; DOACs = 1574) were included. Mean age was 74.2 and 75.3 years in the LAAO and DOAC group respectively. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.90, 95% CI 0.40-2.03; p = 0.81), ischemic stroke/TIA (RR 1.15, 95% CI 0.80-1.65; p = 0.46; $I^{2}$ = 0) and clinically significant bleeding (RR 0.77, 95% CI 0.50-1.17; p = 0.22; $I^{2}$ = 69) between the groups.

Conclusions: Among patients with AF, LAAO was comparable to DOACs with similar efficacy and safety profiles.

Keywords: atrial fibrillation; bleeding; direct oral anticoagulation; ischemic stroke; left atrial appendage occlusion.

Publication types

Systematic Review