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Most left atrial thrombi are believed to reside in the left atrial appendage (LAA). Thus, closure of the LAA (LAAC) “should” lower the risks for left atrial thrombi and, therefore, thrombo-embolism. Two randomized, controlled trials (PROTECT AF and PREVAIL) compared outcomes in patients with nonvalvular atrial fibrillation randomized to warfarin or the Watchman, the only FDA-approved LAA occlusion device (NEJM JW Cardiol Oct 2009 and Lancet 2009; 374:534 and NEJM JW Cardiol Sep 2014 and J Am Coll Cardiol 2014; 64:1). Now, researchers perform a meta-analysis of patient-level data from the two cohorts (N=1114) with a longer, 5-year follow-up (4343 person-years).
The composite endpoint (stroke, systemic embolism, or cardiovascular or unexplaine…