LAA Closure May Be Favored Over Oral Anticoagulation in Atrial Fibrillation: Study
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
USA: An updated meta-analysis incorporating the CHAMPION-AF trial has revealed that percutaneous left atrial appendage (LAA) closure may offer greater overall benefit than oral anticoagulation for selected patients with atrial fibrillation. The findings, published in Stroke, support LAA closure as an increasingly important alternative to long-term anticoagulant therapy.
Atrial thrombi in patients with nonvalvular atrial fibrillation (AF) predominantly originate in the left atrial appendage, making the structure an important target for stroke prevention. Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC), but its comparative effectiveness for stroke prevention and bleeding reduction remains uncertain.
Prince K. Pekyi-Boateng, MBBS, Department of Neurology, University of Utah School of Medicine, Salt Lake City, and colleagues conducted a systematic review and meta-analysis to assess the outcomes associated with LAAC compared with OAC. The analysis also examined whether the effects differed according to bleeding risk, eligibility for anticoagulation, and the type of anticoagulant used as the comparator.
The researchers searched PubMed, Scopus, and Embase from database inception through April 15, 2026, identifying randomized controlled trials that compared percutaneous LAAC with OAC in adults with nonvalvular AF. The analysis included six randomized trials conducted between 2014 and 2026 across 358 sites in North America, Europe, and Asia, involving 7,028 patients. Two trials compared LAAC with warfarin, while four evaluated it against direct oral anticoagulants.
The pooled analysis incorporated evidence from the recently reported CHAMPION-AF and CLOSURE-AF trials, which more than doubled the available randomized evidence in this area.
The key findings were:
- Overall stroke incidence did not differ significantly between LAAC and OAC, with an odds ratio (OR) of 1.10 (95% CI, 0.78–1.56).
- Ischemic stroke occurred more frequently following LAAC than OAC (OR, 1.41; 95% CI, 1.07–1.86), although the evidence did not reach the prespecified information size required for a definitive conclusion.
- LAAC significantly reduced nonprocedural bleeding compared with OAC (OR, 0.58; 95% CI, 0.35–0.96), representing the only outcome to reach sufficient statistical information size.
- The reduction in nonprocedural bleeding was observed among patients with standard bleeding risk and those undergoing postablation treatment, but was not demonstrated in patients at high bleeding risk.
- The overall trial population was largely composed of patients eligible for anticoagulation, with relatively few participants having a previous stroke.
The findings suggest that the principal advantage of LAAC may lie in reducing bleeding associated with long-term anticoagulant use rather than providing stroke prevention equivalent to OAC. In particular, patients with standard-to-moderate bleeding risk appeared to derive the clearest bleeding-related benefit.
The authors concluded that LAAC should be viewed primarily as a strategy to lower nonprocedural bleeding risk in appropriately selected anticoagulation-eligible patients, rather than as a direct replacement for oral anticoagulation for stroke prevention. The findings also highlight the need for careful patient selection based on bleeding characteristics rather than stroke-risk assessment alone.
Reference:
https://doi.org/10.1161/STROKEAHA.126.057089
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