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September 8, 2026Thrombosis and Haemostasis

LAAC linked to less clinically relevant bleeding but more ischemic strokes versus OACs in AF.

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Why the study?

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

Population

Patients with atrial fibrillation

Comparison

Left atrial appendage closure (LAAC) vs Oral anticoagulants or standard of care for…

Design

Review

Key result

Left atrial appendage closure is associated with less clinically-relevant bleeding but more ischemic strokes compared to oral anticoagulants in patients with atrial fibrillation.

Authors

ACA. John Camm

Discussion

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Overview

May favor LAAC in OAC-intolerant AF for bleeding reduction; challenges consensus and leaves open RCT confirmation before guideline shifts.

Key Points

  • To evaluate the clinical efficacy and safety of left atrial appendage closure (LAAC) compared to oral anticoagulants in patients with atrial fibrillation across recent trials.
  • Reviewed outcomes from early warfarin-comparator trials and recent clinical trials (including CHAMPION-AF, OPTION, CLUSTER-AF, and ASAP TOO) comparing LAAC to direct oral anticoagulants or standard care.
  • Assessed pooled meta-analytic outcomes evaluating ischemic stroke, total stroke, device-related thrombosis, and clinically relevant bleeding.
  • Recent meta-analyses show that LAAC significantly reduces clinically relevant bleeding compared with oral anticoagulation.
  • LAAC is associated with a higher incidence of ischemic stroke compared to direct oral anticoagulants, but total stroke rates do not differ significantly between treatments (specific numerical event rates and effect sizes not provided).
  • Trial outcome discrepancies are primarily attributed to varying patient phenotypes, operator experience, and peri-procedural risks rather than inherent device failure.

Structured PICO

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

P
Population
Patients with atrial fibrillation
I
Intervention
Left atrial appendage closure (LAAC)
C
Comparator
Oral anticoagulants (warfarin or direct OACs) or standard of care for OAC-intolerant patients
O
Outcome
Thrombo-embolic AF-related stroke and clinically-relevant bleedinghard clinical

LAAC is associated with less clinically-relevant bleeding but more ischemic strokes than OACs, offering a therapeutic alternative for OAC-intolerant patients and prompting a potential change in guideline recommendations.

Cite This Study

A. John Camm (2026) conducted a review in Atrial fibrillation. Left atrial appendage closure (LAAC) vs. Oral anticoagulants (OACs) was evaluated. Left atrial appendage closure is associated with less clinically-relevant bleeding but more ischemic strokes compared to oral anticoagulants in patients with atrial fibrillation.

synapsesocial.com/papers/6a9fd76758e84d0ff5b45ff9https://doi.org/10.1055/a-2945-5484
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Also Consider

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

  1. 1Left Atrial Appendage Closure versus Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation: Long-Term Outcomes from Four Randomized Trials2025 · 25 citations
  2. 2Left Atrial Appendage Closure vs Direct Oral Anticoagulants in Atrial Fibrillation2026 · 3 citations
  3. 3Left Atrial Appendage Closure vs. Oral Anticoagulation in Patients With Atrial Fibrillation: An Updated Systematic Review and Meta‐Analysis of Randomized Controlled Trials2026 · 1 citations
  4. 4Left Atrial Appendage Closure Versus Oral Anticoagulation for Stroke Prevention in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2026
  5. 5Percutaneous Left Atrial Appendage Closure: Current Evidence and Procedural Insights2025 · 1 citations