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 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. Hussein^11,*

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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

^*Correspondence: husseia@ccf.org (Ayman A. Hussein)

Rev. Cardiovasc. Med. 2023, 24(2), 44; https://doi.org/10.31083/j.rcm2402044

Submitted: 25 March 2022 | Revised: 1 October 2022 | Accepted: 12 October 2022 | Published: 2 February 2023

(This article belongs to the Special Issue New Insights in Treatment of Atrial Fibrillation)

This is an open access article under the CC BY 4.0 license.

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

left atrial appendage occlusion

atrial fibrillation

direct oral anticoagulation

ischemic stroke

bleeding

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174