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June 20, 2026Journal of ArrhythmiaOpen Access

LAAC cuts non-procedure-related bleeding ~52% and lowers all-cause mortality vs OAC in AF patients.

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Why the study?

Does left atrial appendage closure reduce stroke, bleeding, and mortality compared to oral anticoagulation in patients with atrial fibrillation?

Population

3116 patients with atrial fibrillation from 4 randomized controlled trials

Comparison

Left atrial appendage closure (LAAC) vs Oral anticoagulation (OAC)

Design

Meta-analysis

Key result

Left atrial appendage closure significantly reduced non-procedure-related bleeding (RR 0.48; 95% CI 0.37-0.61; p<0.00001) and all-cause mortality compared to oral anticoagulation in AF patients.

Authors

CCChika ChilakaLagos State UniversityHKHassan Dawood KhanRashid Latif Medical CollegeMSMuhammad Uzair SarfrazKing Edward Medical University

Discussion

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Overview

LAAC may be favored over OAC in selected AF patients to cut bleeding and mortality; extends meta-analytic support from randomized data.

Key Points

  • This systematic review aims to compare left atrial appendage closure with oral anticoagulation in patients with atrial fibrillation regarding safety and efficacy.
  • Conducted a systematic search of multiple databases for randomized controlled trials on left atrial appendage closure versus oral anticoagulation.
  • Four trials were included following independent study selection, data extraction, and quality assessment by two reviewers.
  • Meta-analyses were performed using RevMan software, reporting outcomes as risk ratios for dichotomous data and mean differences for continuous data.
  • LAAC significantly reduced non–procedure–related bleeding (RR: 0.48, 95% CI: 0.37–0.61; p < 0.00001).
  • LAAC reduced all–cause mortality (RR: 0.74, 95% CI: 0.55–0.99; p = 0.04).
  • A marginal reduction was observed in stroke, systemic embolism, or death composite outcome (RR: 0.77, 95% CI: 0.59–1.00; p = 0.05).

Study Design

Type

Meta-Analysis (n=3,116)

Structured PICO

Does left atrial appendage closure reduce stroke, bleeding, and mortality compared to oral anticoagulation in patients with atrial fibrillation?

P
Population
3,116 participants with atrial fibrillation analyzed across 4 randomized controlled trials comparing left atrial appendage closure to oral anticoagulation.
I
Intervention
Left atrial appendage closure (LAAC)
C
Comparator
Oral anticoagulation (OAC)
O
Outcome
Stroke (all, ischemic, hemorrhagic), systemic embolism, major bleeding, non-procedure-related bleeding, and mortalitycomposite

Main Result

Relative Risk: 0.48 (95% CI 0.37–0.61)

p-value: p=<0.00001

Left atrial appendage closure is a viable alternative to oral anticoagulation in selected AF patients, offering comparable stroke prevention efficacy with significant reductions in non-procedure-related bleeding and all-cause mortality.

Cite This Study

Chilaka et al. (2026) conducted a meta-analysis in Atrial Fibrillation (n=3,116). Left atrial appendage closure vs. Oral anticoagulation was evaluated on non-procedure-related bleeding (RR 0.48, 95% CI 0.37-0.61, p=<0.00001). Left atrial appendage closure significantly reduced non-procedure-related bleeding (RR 0.48; 95% CI 0.37-0.61; p<0.00001) and all-cause mortality compared to oral anticoagulation in AF patients.

synapsesocial.com/papers/6a3721e201fe431c25188952https://doi.org/10.1002/joa3.70382
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