Percutaneous left atrial appendage occlusion versus oral anticoagulation in nonvalvular atrial fibrillation

Authors

• Ameer Odeh, Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Mohammad Riyad Salah, University of Chicago Medical Center, Chicago, IL, USA; Endeavor Health - NorthShore Hospitals, Evanston, IL, USA.
• Jena Itraish, Department of Biology, University of Florida, Gainesville, FL, USA.
• Tianze Jiao, Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
• Andrew J. Foy, Beebe Hospital, Lewes, DE, USA.
• John Mandrola, Baptist Health Louisville, Louisville, KY, USA.
• Mohammed Ruzieh, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA. Electronic address: [email protected].

Recommended Citation

Odeh A, Shubietah A, Salah MR, et al. Percutaneous left atrial appendage occlusion versus oral anticoagulation in nonvalvular atrial fibrillation. Trends Cardiovasc Med. Published online September 15, 2026. doi:10.1016/j.tcm.2026.09.002

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Percutaneous left atrial appendage occlusion (pLAAO) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation, yet no individual trial has been powered to detect meaningful differences in ischemic stroke or systemic embolism. We evaluated the comparative efficacy and safety of pLAAO vs OAC in nonvalvular atrial fibrillation using pooled analysis of randomized controlled trials. We searched PubMed, Embase, and Cochrane Central through April 3, 2026. Risk ratios were pooled using a random-effects model. Bayesian and trial sequential analyses were performed to assess non-inferiority using a prespecified margin of RR = 1.40, and power of available evidence. The primary efficacy endpoint was ischemic stroke or systemic embolism; primary safety endpoints were major bleeding and hemorrhagic stroke. Seven RCTs enrolling 7353 patients were included. Compared with OAC, pLAAO was associated with significantly more ischemic stroke or systemic embolism (3.3% vs 2.0%; RR 1.48, 95% CI 1.06-2.07). Hemorrhagic stroke was numerically lower with pLAAO but non-significant (0.6% vs 0.9%; RR 0.65, 95% CI 0.39 - 1.07). Major bleeding did not differ (8.3% vs 8.1%; RR 0.98, 95% CI 0.84-1.15). Bayesian analysis yielded a posterior probability of non-inferiority of 45.3%, failing the prespecified margin. Trial sequential analysis confirmed insufficient evidence to establish non-inferiority, and the major bleeding Z-curve entered the futility zone. Compared with OAC, pLAAO was not non-inferior for the outcome of ischemic stroke or systemic embolism, and did not significantly reduce major bleeding, though hemorrhagic stroke was numerically lower with pLAAO.

Type

Article

PubMed ID

42744191