Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation: Network Meta-Analyses.

Authors

Yuriko Hiruma, Tadao Aikawa, Iwanari Kawamura, Masao Iwagami, Polydoros Kampaktsis, Alexandros Briasoulis, Ali Fatehi Hassanabad, Kaveh Hosseini, Pier Pasquale Leone, Leandro Slipczuk, Jose Wiley, Eric Secemsky, Roger Laham, Toshiki Kuno

Published in

JACC. Advances. Volume 5. Issue 10 Pt 2. Pages 103269. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

Left atrial appendage occlusion (LAAO) is a treatment option to prevent thromboembolic events in patients with atrial fibrillation. However, it remains unclear whether LAAO offers superior efficacy and safety compared with oral anticoagulation for these patients.
This study aimed to assess the efficacy and safety of LAAO vs direct oral anticoagulants (DOACs).
We reviewed randomized controlled trials comparing oral anticoagulation and LAAO, using MEDLINE and CENTRAL. The primary outcome was a composite of stroke, systemic embolism, and cardiovascular death, whereas the safety outcome was major bleeding. Two network meta-analyses were conducted to assess LAAO vs DOAC, incorporating indirect comparisons: 1 comparing LAAO, DOACs, and vitamin K antagonist (3 arms), and the other comparing Watchman, Amulet, DOACs, and vitamin K antagonist (4 arms).
A total of 67,693 patients from 11 randomized controlled trials were included, of whom 5,735 underwent LAAO. In the three-arm network meta-analysis, LAAO and DOACs demonstrated statistically similar risks for both the primary efficacy outcome (HR: 1.02; 95% CI: 0.88-1.19; I² = 0%) and the safety outcome (HR: 0.98; 95% CI: 0.78-1.23; I² = 70.5%). In the 4-arm network meta-analysis, both Amulet and Watchman were associated with similar risks of the primary outcome, comparable to those of DOACs, as well as the risk of major bleeding.
LAAO devices did not demonstrate statistical superiority over DOACs in reducing thromboembolic events and major bleeding. Further trials are warranted to define patients for whom LAAO may offer the most significant benefit, such as those with high bleeding risk (CRD420251237886).

PMID:
42777587
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.