When Is Clinical Benefit Greater with Left Atrial Occlusion vs. Anticoagulation in Atrial Fibrillation?

Prospective randomized trials comparing left atrial appendage occlusion (LAAO) against warfarin for stroke prevention in patients with nonvalvular atrial fibrillation have shown a similar benefit in short-term follow-up, but with increasing follow-up, LAAO patients appear to have less stroke, systemic embolism, or cardiovascular death (NEJM JW Cardiol Sep 2014 and J Am Coll Cardiol 2014; 64:1; NEJM JW Cardiol Jan 2015 and JAMA 2014; 312:1988). Using individual-level data from these trials, researchers constructed a Markov decision analysis model to assess the probability of clinical benefit of LAAO over anticoagulation based on risk scores for stroke and bleeding (CHA₂DS₂-VASc and HAS-BLED scores, respectively). Clinical benefit was measure…