JAMA cardiology
October 1, 2026 · via Europe PMC
Catheter-Based Left Atrial Appendage Closure vs Oral Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Laudani C, Bujak K, Giacoppo D, +9 more, Capodanno D.
AI summary — for doctors, generated from the abstract only
Compared with oral anticoagulation, left atrial appendage closure did not reduce overall stroke or major bleeding and increased ischemic stroke, so it is not supported as routine first-line therapy.
What was studied
Systematic review and meta-analysis of 8 randomized trials (7434 patients) comparing catheter-based LAAC with oral anticoagulation in AF at moderate-to-high stroke risk, with about 38 months mean follow-up.
Key findings
- Stroke (IRR 1.08, 95% CI 0.82-1.41) and major bleeding (IRR 0.96, 95% CI 0.81-1.14) did not differ significantly.
- Ischemic stroke was higher with LAAC (IRR 1.34, 95% CI 1.01-1.77).
- Nonprocedural major bleeding was lower with LAAC (IRR 0.73, 95% CI 0.58-0.92).
- Periprocedural events per 1000 included 5 strokes, 9 bleeds, 5 device embolizations and 9 pericardial effusions.
Clinical relevance
This supports oral anticoagulation as first-line stroke prevention and positions LAAC for patients with a specific reason to avoid long-term anticoagulants.
Who should care
Limitations
Pooled trials differ in devices, comparators and populations, and the ischemic stroke finding has a confidence interval close to 1.
Reserve LAAC for patients with contraindications or intolerance to anticoagulation rather than offering it as a routine first-line alternative.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Importance
In patients with atrial fibrillation (AF), oral anticoagulation (OAC) is the gold standard for preventing ischemic stroke, at the expense of a higher risk of bleeding. Catheter-based left atrial appendage closure (LAAC) has been proposed as an alternative strategy to prevent stroke, but the efficacy and safety compared to OAC are uncertain.
Objective
To evaluate the efficacy and safety of catheter-based LAAC compared to OAC in patients with AF at high risk of stroke.
Data sources
PubMed, Cochrane Central, and Web of Science were screened up to March 2026. The websites of leading cardiology societies, news outlets, and reference lists of each eligible study were also inspected.
Study selection
Studies enrolling patients with AF randomly assigned to catheter-based LAAC or OAC and reporting at least 1 outcome of interest were included.
Data extraction and synthesis
Two investigators independently extracted data of interest and assessed data quality. Catheter-based LAAC vs OAC comparisons were pooled as incidence rate ratios (IRRs) using a frequentist random-effect model.
Main outcomes and measures
Primary and coprimary outcomes were long-term stroke and major bleeding. Secondary outcomes included the composite of cardiovascular death, stroke, or systemic embolism, all-cause death, the single components of the composite end point, ischemic stroke, hemorrhagic stroke, and nonprocedural major bleeding. Periprocedural events (ie, stroke, major bleeding, death, device embolization, and pericardial effusion) were also combined.
Results
Eight trials (7434 patients) were included in the meta-analysis. After a weighted mean follow-up of 37.9 months, no significant differences were detected for stroke (IRR, 1.08; 95% CI, 0.82-1.41) and major bleeding (IRR, 0.96; 95% CI, 0.81-1.14). However, catheter-based LAAC was associated with a higher risk of ischemic stroke (IRR, 1.34; 95% CI, 1.01-1.77) and a lower risk of nonprocedural major bleeding (IRR, 0.73; 95% CI, 0.58-0.92) compared with OAC. Periprocedural events per 1000 patients were 5 strokes, 9 episodes of bleeding, 1 death, 5 episodes of device embolization, and 9 pericardial effusions.
Conclusions and relevance
In patients with AF, at long-term follow-up, transcatheter LAAC was associated with similar rates of any type of stroke and major bleeding compared with OAC, while increasing the risk of ischemic stroke and lowering the risk of nonprocedure-related major bleeding. These findings do not support the routine use of LAAC as a first-line strategy for stroke prevention in patients with AF at moderate to high risk of stroke.
DOI
10.1001/jamacardio.2026.2640
PMID
42646743
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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