ReviewCureus2025
Comparative Safety and Efficacy of Left Atrial Appendage Occlusion Technologies for Prevention of Stroke and Bleeding in Atrial Fibrillation: A Comprehensive Meta-Analysis of Watchman Versus Oral Anticoagulation and Alternative Device Platforms.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention in atrial fibrillation. We performed a systematic review and meta-analysis comparing Watchman (Boston Scientific Corporation, Marlborough, MA) with oral anticoagulants (OACs) and alternative LAAO devices. PubMed, EBSCO, and ClinicalTrials.gov were searched (January 2005 to August 2025) for randomised trials and observational studies comparing Watchman with OACs or other devices in adults with atrial fibrillation (minimum one-month follow-up). Twenty-one studies (eight randomised, 13 observational; n=12,357) were analysed. Results reflect combined randomised and observational evidence, with heterogeneity addressed using random-effects models. Most comparators were warfarin; DOAC-specific data were limited. Versus OACs, LAAO reduced transient ischaemic attack (odds ratio (OR) 0.72), haemorrhagic stroke (OR 0.41), all-cause mortality (OR 0.73), and cardiovascular mortality (OR 0.57), with similar ischaemic stroke rates (OR 1.09). Ten studies contributed device-device comparisons. Versus other devices, Watchman had fewer complications (OR 0.67) but more major peridevice leaks (OR 1.84). Watchman showed a consistently more favourable safety profile compared to others. Device-related complications were significantly lower (OR 0.67), including markedly reduced device embolisation (OR 0.45) and procedural bleeding (OR 0.68). Watchman also demonstrated fewer major procedural complications and a lower rate of pericardial effusion requiring intervention. Efficacy outcomes, including ischaemic stroke, transient ischaemic attack (TIA), haemorrhagic stroke, and systemic embolism, were comparable across devices, with no significant differences detected. Follow-up duration varied across studies, though absolute event rates remained low. Publication bias and residual confounding may influence mortality estimates, as device-generation reporting was incomplete. In conclusion, LAAO reduces haemorrhagic stroke and mortality compared with OACs while maintaining equivalent ischaemic stroke protection. Among devices, Watchman demonstrates superior procedural safety but increased leak rates.
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