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July 17, 2026Journal of Clinical MedicineOpen Access

Catheter-based LAAO shows no benefit over medical therapy for major events but reduces nonprocedural bleeding.

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Why the study?

Does catheter-based LAAO reduce the composite primary endpoint compared to medical therapy in patients with atrial fibrillation?

Population

7,073 patients with atrial fibrillation pooled from 6 RCTs

Comparison

Catheter-based left atrial appendage occlusion vs Medical therapy, including direct oral…

Design

Meta-analysis

Key result

Catheter-based LAAO showed no significant difference in the composite endpoint versus medical therapy (RR 1.02; 95% CI 0.85-1.23), but significantly reduced nonprocedural bleeding.

Authors

MKMuhammad Aslam KhanAMAnza MuhammadSNSheeza Nawaz

Discussion

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Overview

LAAO remains a viable nonpharmacologic option for AF stroke prevention; confirms pooled RCT evidence alongside contemporary DOAC therapy.

Key Points

  • To evaluate the comparative effectiveness and safety of left atrial appendage occlusion (LAAO) versus medical therapy in patients with atrial fibrillation.
  • Performed a systematic review and meta-analysis of randomized controlled trials comparing LAAO with medical therapy.
  • Searched PubMed, CENTRAL, and ScienceDirect up to May 2026.
  • Pooled dichotomous outcomes using risk ratios with 95% confidence intervals.
  • LAAO did not significantly differ from medical therapy in composite endpoint (RR 1.02; 95% CI 0.85–1.23) or mortality rates.
  • LAAO significantly reduced nonprocedural major bleeding (RR 0.54; 95% CI 0.46–0.63; p < 0.0001).
  • Wide confidence intervals for ischemic stroke/TIA and systemic embolism suggest uncertainty in thromboembolic events after LAAO.

Study Design

Type

Meta-Analysis (n=7,073)

Structured PICO

Does catheter-based LAAO reduce the composite primary endpoint compared to medical therapy in patients with atrial fibrillation?

P
Population
7,073 participants with atrial fibrillation from 6 randomized controlled trials comparing catheter-based LAAO with medical therapy.
I
Intervention
Catheter-based left atrial appendage occlusion (LAAO)
C
Comparator
Medical therapy, including direct oral anticoagulants (DOACs)
O
Outcome
Composite primary endpointcomposite

Main Result

Relative Risk: 1.02 (95% CI 0.85–1.23)

LAAO provides similar overall efficacy to medical therapy for stroke prevention in atrial fibrillation but significantly reduces nonprocedural bleeding, supporting its use in selected patients with high bleeding risk.

Limitations

  • Confidence intervals for ischemic stroke/TIA and systemic embolism remained wide and cannot exclude a clinically meaningful excess of thromboembolic events after LAAO.
  • Uncertainty for rare thromboembolic outcomes remains to be resolved.
  • Wide confidence intervals for ischemic stroke/TIA and systemic embolism cannot exclude a clinically meaningful excess of thromboembolic events after LAAO

Cite This Study

Khan et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=7,073). Catheter-based left atrial appendage occlusion (LAAO) vs. Medical therapy (including DOACs) was evaluated on Composite primary endpoint (RR 1.02, 95% CI 0.85-1.23). Catheter-based LAAO showed no significant difference in the composite endpoint versus medical therapy (RR 1.02; 95% CI 0.85-1.23), but significantly reduced nonprocedural bleeding.

synapsesocial.com/papers/6a59c664a58755010b47197dhttps://doi.org/10.3390/jcm15145529
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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. 2Pooled Efficacy and Safety of Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants or Antiplatelets: A Meta‐Analysis of the Landmark Randomized Trials2026
  3. 3Left Atrial Appendage Occlusion Devices Focused on Complications of Therapy2025
  4. 4Left Atrial Appendage Closure vs. Oral Anticoagulation in Patients With Atrial Fibrillation: An Updated Systematic Review and Meta‐Analysis of Randomized Controlled Trials2026
  5. 5Left Atrial Appendage Closure Versus Oral Anticoagulation for Stroke Prevention in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2026