Left atrial appendage occlusion devices vs direct oral anticoagulants for atrial fibrillation: An updated systematic review and meta-analysis

被引:2
作者
Fernandes, Julia M. [1 ]
Pinheiro, Rafael P. S. [2 ]
Serpa, Frans [3 ]
de Andrade, Naieli M. [4 ]
Pereira, Vinicius [5 ]
Sbardelotto, Angelo E. E. [2 ]
Gomes, Wilton F. [6 ]
机构
[1] Fac Israelita Ciencias Saude Albert Einstein, Rua Comendador Elias Jafet 755, BR-05653000 Sao Paulo, SP, Brazil
[2] Univ Fed Rio De Janeiro, Rua Prof Rodolpho Paulo Rocco 255, BR-21941617 Rio De Janeiro, RJ, Brazil
[3] Univ Texas Southwestern Med Ctr, Dept Internal Med, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
[4] Escola Bahiana Med & Saude Publ Bahia, Ave Dom Joao VI 275, BR-40290000 Salvador, BA, Brazil
[5] Univ Austral, Fac Ciencias Biomed, Ave Juan Domingo Peron 1500, RA-B1629 Pilar, Buenos Aires, Argentina
[6] Univ Fed Parana, INC Hosp, Hosp Santa Casa Misericordia Curitiba, Fac Pequeno Principe,Dept Intervent Cardiol, Rua Jeremias Maciel Perretto 300, BR-81210310 Curitiba, Parana, Brazil
关键词
WATCHMAN DEVICE; CLOSURE; WARFARIN; OUTCOMES; STROKE; PREVENTION; MANAGEMENT; SAFETY;
D O I
10.1016/j.cpcardiol.2024.102880
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial. Methods: A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions. Results: Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events. Conclusion: LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.
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页数:14
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