B-PO05-154 AN UPDATED META-ANALYSIS COMPARING LEFT ATRIAL APPENDAGE CLOSURE AND ORAL ANTICOAGULATION

Abstract

Left atrial appendage closure (LAAC) trials such as PREVAIL and PROTECT revealed non-inferiority of LAAC compared to warfarin. The recently published PRAGUE study showed that LAAC was non-inferior to direct oral anti-coagulants. Current guidelines give a IIb recommendation for LAAC in patients with non-valvular atrial fibrillation (NVAF) with increased risk of stroke and contraindication to long-term anticoagulation. We performed an updated meta-analysis of randomized controlled trials (RCTs) comparing LAAC to oral anticoagulation (OAC). We performed a literature review in PubMed, SCOPUS, and Cochrane for related articles. The search yielded 83 publications, out of which three RCT’s (PREVAIL, PRAGUE and PROTECT) were included. The Mantel- Haenszel random effects model was used to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were ischemic stroke, hemorrhagic stroke, systemic embolization, cardiovascular mortality, major bleeding and non-procedure related major bleeding. The trials included 1516 patients, of which 933 received LAAC and 583 received OAC. The rate of hemorrhagic stroke (OR = 0.21, 95% CI [0.08-0.57], P=0.002), cardiovascular mortality (OR = 0.62, 95% CI [0.39-0.98], P=0.04) and non-procedure related major bleeding (OR = 0.46, 95% CI [0.31-0.67], P<0.0001) was significantly lower in the LAAC group compared to OAC group. There was no significant difference in ischemic stroke, systemic embolization and major bleeding rates between the two groups. In patients with NVAF eligible for anti-coagulation but with high bleeding risk, LAAC is a safe and effective treatment option.