Abstract 13742: Left Atrial Appendage Closure versus Direct Oral Anticoagulant Outcomes Among High Risk Atrial Fibrillation: A Meta-Analysis

Abstract

Introduction: Relevant data comparing the beneficial approach towards atrial fibrillation (AF) patients with left atrial appendage closure (LAAC) and direct oral anticoagulation therapy (DOAC) is limited and not well known. Hypothesis: We aim to evaluate the clinical outcomes among AF patients who received LAAC and DOAC therapy. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing cardiovascular outcomes among LAAC versus DOAC. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Results: A total of 6315 patients (LACC: 2703, DOACs: 3612) from six studies consisting of one RCT and five propensity-score-matched studies were included in our analysis. Compared with DOAC, LAAC cohort was associated with a significant reduction in primary composite outcome of ischemic stroke, major bleeding and all-cause mortality [OR 0.62, (95% CI 0.45 to 0.84), p=0.002]. Similarly, LAAC cohort showed a significantly reduced all-cause mortality [OR 0.61, (95% CI 0.43 to 0.87), p=0.006], CV mortality [OR 0.56, (95% CI 0.44 to 0.71), p<0.001] and post-procedural bleeding [OR 0.57, (95% CI 0.40 to 0.83), p=0.003]. There were no significant differences in terms of ischemic stroke/TIA [OR 1.15, (95% CI 0.88 to 1.52), p=0.31] and systemic embolism [OR 1.01, (95% CI 0.49 to 2.07), p=0.97] between patients receiving LAAC or DOAC. Conclusions: LAAC shows superiority over DOAC in terms of reducing the all-cause mortality, cardiovascular mortality and major bleeding events among patients with high risk atrial fibrillation, however large multicenter randomised trials are warranted to further justify these findings among large sample size.