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June 19, 2026BMC Cardiovascular DisordersOpen Access

Direct oral anticoagulants versus vitamin K antagonists after left atrial appendage occlusion: a systematic review and meta-analysis

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Why the study?

Do direct oral anticoagulants reduce stroke, systemic embolism, and major hemorrhage compared to vitamin K antagonists in patients undergoing left atrial appendage occlusion?

Population

Patients with non-valvular atrial fibrillation undergoing left atrial appendage occlusion pooled from 21…

Comparison

Direct oral anticoagulants (DOACs) vs Vitamin K antagonists (VKAs)

Design

Meta-analysis

Key result

Direct oral anticoagulants significantly reduced the risk of major bleeding (OR 0.88) compared to vitamin K antagonists following left atrial appendage occlusion, with comparable thromboembolic protection.

Authors

YDYuanhua DaiJCJun ChangJGJing Guo

Discussion

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Overview

Supports preferring DOACs over VKAs to lower serious bleeding risk; confirms safety advantage in updated meta-analysis.

Key Points

  • This analysis aims to compare the effectiveness and safety of direct oral anticoagulants and vitamin K antagonists after left atrial appendage occlusion for stroke prevention.
  • Comprehensive literature search conducted in Web of Science, Cochrane Library, Embase, and PubMed.
  • Included studies focused on patients who underwent left atrial appendage occlusion and received either DOAC or VKA therapies.
  • Meta-analysis employed random-effects models to accommodate heterogeneity among studies.
  • DOACs showed a significantly lower incidence of serious bleeding (OR = 0.88, 95% CI: 0.80–0.98) compared to VKAs.
  • The occurrence of major adverse events was also lower for DOACs (OR = 0.88, 95% CI: 0.82–0.95) without a significant difference in stroke or systemic embolism rates (OR = 0.86, 95% CI: 0.69–1.05).
  • Secondary outcomes like peri-device leaks and device-related thrombosis did not differ significantly between the groups.

Study Design

Type

Meta-Analysis

Structured PICO

Do direct oral anticoagulants reduce stroke, systemic embolism, and major hemorrhage compared to vitamin K antagonists in patients undergoing left atrial appendage occlusion?

P
Population
Patients with non-valvular atrial fibrillation undergoing left atrial appendage occlusion treated with either DOAC or VKA regimens across 21 included studies.
I
Intervention
Direct oral anticoagulants (DOACs)
C
Comparator
Vitamin K antagonists (VKAs)
O
Outcome
Transient ischemic attack (TIA), systemic embolism (SE), ischemic stroke, and major hemorrhagehard clinical

Main Result

Odds Ratio: 0.88 (95% CI 0.8–0.98)

Following left atrial appendage occlusion, DOACs offer comparable thromboembolic protection to VKAs but with a significantly lower risk of major bleeding and overall major adverse events.

Limitations

  • Most included studies were non-randomized, introducing potential residual confounding and selection bias.
  • Moderate-to-low certainty of evidence according to GRADE assessment.
  • Variability and incomplete reporting of DOAC dosing regimens (under-dosing and over-dosing) across studies.
  • Heterogeneity in the definitions of major bleeding and composite outcomes across the included studies.
  • Potential publication bias observed for major bleeding and any major adverse event outcomes.
  • Most available evidence is derived from non-randomized studies
  • Subject to residual confounding
  • Selection bias
  • Moderate-to-low certainty of evidence

Cite This Study

Dai et al. (2026) conducted a meta-analysis in Non-valvular atrial fibrillation (NVAF). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Major bleeding (OR 0.88, 95% CI 0.80-0.98). Direct oral anticoagulants significantly reduced the risk of major bleeding (OR 0.88) compared to vitamin K antagonists following left atrial appendage occlusion, with comparable thromboembolic protection.

synapsesocial.com/papers/6a3599c2dd3be7785e70ee12https://doi.org/10.1186/s12872-026-06132-w
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparative Efficacy and Safety of Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and Meta-Analysis2025 · 1 citations
  2. 2Antithrombotic strategies and DOAC dosing following left atrial appendage occlusion: a network meta-analysis2025 · 11 citations
  3. 3Valve-Specific Comparative Effectiveness of Direct Oral Anticoagulants Versus Vitamin K Antagonists After Surgical Valve Procedures in Atrial Fibrillation: A Systematic Review and Meta-Analysis2026
  4. 4Left Atrial Appendage Closure vs Direct Oral Anticoagulants in Atrial Fibrillation2026 · 2 citations
  5. 5Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Valve Replacement: An Umbrella Review2025 · 1 citations