Cardiology · 2 h ago
Meta-analysis finds higher ischemic stroke risk with left atrial appendage occlusion
A meta-analysis of six randomized trials involving 7,004 patients with atrial fibrillation compared left atrial appendage occlusion with oral anticoagulation. Occlusion was associated with higher ischemic stroke risk and less non-major bleeding, without significant differences in mortality or major bleeding.
- Six randomized trials included 7,004 patients with atrial fibrillation.
- LAAO increased relative ischemic stroke risk by 32%.
- Non-major bleeding was reduced by 50% with LAAO.
- Mortality and major bleeding differences were not statistically significant.
A meta-analysis published in BMC Medicine assessed the safety and efficacy of left atrial appendage occlusion (LAAO) versus oral anticoagulation in atrial fibrillation. Researchers searched MEDLINE, EMBASE and Cochrane for randomized trials from January 2000 through April 2026. Six trials included 7,004 patients: 3,681 assigned to LAAO and 3,323 to anticoagulation. The primary outcome was all-cause mortality.
Mortality did not differ significantly between groups (risk ratio [RR] 1.03, 95% CI 0.87–1.22). LAAO was associated with higher ischemic stroke risk (RR 1.32, 95% CI 1.04–1.68) and lower non-major bleeding risk (RR 0.50, 95% CI 0.43–0.58). There were no statistically significant differences in major bleeding (RR 0.92, 95% CI 0.73–1.16) or systemic embolism (RR 1.29, 95% CI 0.41–4.07). Reported statistical heterogeneity was zero for these outcomes.
The findings support cautious, individualized consideration of LAAO, balancing ischemic stroke risk against reduced non-major bleeding. The supplied report does not specify follow-up duration, absolute event rates, devices used or the distribution of anticoagulant regimens, limiting interpretation for contemporary practice. Nonsignificant differences in mortality and major bleeding should not be interpreted as proof of equivalence.
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BMC Medicine: Left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.