Left Atrial Appendage Closure vs. Anticoagulation in AFib, Round 2

Clinical Takeaway

: LAA occlusion and DOACs had similar risks of a composite CV outcome, but an increased risk of stroke with LAA occlusion seems likely.

Context

Guidelines say that left atrial appendage occlusion devices are reasonable in patients who aren’t eligible for a direct oral anticoagulant (DOAC) because of high bleeding risk. Whether that benefit extends to patients at lower bleeding risk is being tested. The CLOSURE-AF trial, published a week prior to this one, showed that left atrial occlusion devices were inferior to anticoagulation.

Now in a larger, randomized, controlled, industry-funded trial, 3000 patients were randomized to either left atrial appendage (LAA) occlusion or anticoagulation.

Key Results

At 3 years, the incidence of the primary composite end point — death from cardiovascular causes, stroke, or systemic embolism — was similar in the two groups, occurring in 5.7% of …

Reviewing Author

Mark S. Link, M.D.

Disclosures

Editorial BoardsCirculation; UpToDate