SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Long-term efficacy and safety of left atrial appendage closure vs. oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials.
Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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.
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
2 citing papers in PubMed.
- Left Atrial Appendage Occlusion vs. Oral Anticoagulants: Current Evidence and Debates.Journal of clinical medicine · 2026Review
- Left atrial appendage closure in patients with atrial fibrillation: grey zones involving trials, meta-analysis, and decision-making.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsLeft atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), but its long-term comparative efficacy remains uncertain. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LAAC with OAC in AF. METHODS AND
resultsMEDLINE, Embase, Scopus, and the Cochrane Database of Systematic Reviews were searched through 8 April 2026. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Certainty of evidence (CoE) was assessed using GRADE. Six RCTs involving 7004 participants were included (3681 assigned to LAAC and 3323 to OAC). Compared with OAC, LAAC resulted in a significantly higher risk of ischaemic stroke or systemic embolism (134 vs. 80 events; RR 1.41, 95% CI 1.07-1.86; moderate CoE). No significant differences were observed for any stroke or systemic embolism (RR 1.10, 95% CI 0.87-1.39; moderate CoE), all-cause mortality (RR 0.92, 95% CI 0.77-1.10; high CoE), cardiovascular mortality (RR 0.90, 95% CI 0.67-1.21; moderate CoE), non-cardiovascular mortality (RR 0.92, 95% CI 0.75-1.12; moderate CoE), major bleeding (RR 0.91, 95% CI 0.77-1.08; high CoE), or haemorrhagic stroke (RR 0.58, 95% CI 0.28-1.17; moderate CoE). LAAC reduced the risk of nonprocedural clinically relevant bleeding compared with OAC (RR 0.50, 95% CI 0.43-0.59; high CoE).
conclusionIn patients with AF, LAAC results in a higher risk of ischaemic stroke or systemic embolism than an OAC-based strategy. Compared with OAC, LAAC has no effect on major bleeding or mortality and does not reduce haemorrhagic stroke.
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