ArticleAnnals of medicine and surgery (2012)2025
Left atrial appendage closure versus anticoagulation in the management of atrial fibrillation: a systematic review, meta-analysis, and meta-regression analysis.
Article in Annals of medicine and surgery (2012), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
Background: Left atrial appendage closure (LACC) is a nonpharmacological option for individuals with atrial fibrillation (AF). LAAC procedure is characterized by its minimally invasive nature and is considered an alternative to anticoagulants that were usually the first line of treatment for patients at risk for blood clotting. Methods: A literature search of three databases was conducted and relevant randomized controlled trials (RCTs) were selected. A meta-analysis was performed using a random effect model to calculate risk ratios with 95% confidence intervals, and only the articles with the longest follow-up were included in the meta-regression analysis. Bias was assessed using standard methodologies. We included RCTs involving adult patients with AF that compared LAAC with oral anticoagulation therapy. Non-randomized studies, case series, animal studies, and non-English publications were excluded. Results: We included three studies with a 1516 sample size. All three trials investigated the composite hemorrhagic stroke, all-cause mortality, and non-procedural major bleeding as primary outcomes in addition to the risk of systematic embolism, ischemic stroke, and all major bleeding. Compared to anticoagulation medical therapy, the LAAC device showed a statistically significant reduction in the risk of the composite primary outcome, cardiovascular (CV) death, all-cause deaths, and nonprocedural bleed. When compared to medical management, there was no statistically significant difference in the risk of systemic embolism and all-stroke in the LAAC device group. The age had no significant impact on the primary efficacy outcome using the Meta-regression analysis. Conclusion: LAAC has comparable efficacy in preventing strokes. The risk of CV death, all-cause deaths, and nonprocedural relevant bleeding, all of which are associated with the composite primary outcome is lower in the LAAC group versus the oral anticoagulation therapy and can have even greater efficacy with a longer follow-up period.
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