Left Atrial Appendage Closure Versus Oral Anticoagulation in Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis

被引:11
作者
Al-Abcha, Abdullah [1 ]
Saleh, Yehia [2 ]
Elsayed, Mahmoud [3 ]
Elshafie, Ahmed [1 ]
Herzallah, Khader [4 ]
Baloch, Zulfiqar Qutrio [5 ]
Banga, Sandeep [5 ]
Rayamajhi, Supratik [1 ]
Abela, George S. [5 ]
机构
[1] Michigan State Univ, Dept Internal Med, E Lansing, MI 48824 USA
[2] Houston Methodist DeBakey Heart & Vasc Ctr, Dept Cardiol, Houston, TX USA
[3] Allegheny Gen Hosp, Dept Cardiol, Pittsburgh, PA 15212 USA
[4] Tufts Med Ctr, Dept Cardiol, Boston, MA 02111 USA
[5] Michigan State Univ, Dept Cardiol, E Lansing, MI 48824 USA
关键词
Left atrial appendage; Non-valvular atrial fibrillation; Oral anticoagulation; Direct oral anticoagulation; And warfarin; STROKE PREVENTION; WARFARIN; DABIGATRAN; OUTCOMES;
D O I
10.1016/j.carrev.2021.04.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Left atrial appendage closure (IAAC) devices are an alternative therapy in non-valvular atrial fibrillation (NVAF) patients with contraindications to oral anticoagulation (OAC). However, there are limited data about the clinical outcomes of LAAC devices compared to medical treatment. Methods: A comprehensive research for studies comparing IAAC devices and OAC for patients with NVAF was performed from inception to January 1, 2021. A meta-analysis was performed using a random effect model to calculate odds ratios (OR) with 95% confidence intervals (CIs). Results: Five studies were eligible that included a total of 4778 patients with a median-weighted follow-up period was 2.6 years. Compared to OAC, the LAAC device arm was associated with a lower risk of the composite of stroke, systemic embolism, and cardiovascular death (OR 0.71; 95% CI 0.51-1.00; p = 0.05). LAAC device arm was also associated with a lower risk of all-cause mortality (OR of 0.60, 95% CI 0.46-0.77; p < 0.0001), cardiovascular mortality (OR of 0.57, 95% CI 0.46-0.70; p < 0.00001), hemorrhagic stroke (OR of 0.19, 95% CI 0.07-050; p = 0.0006). all major bleeding (OR of 0.61, 95% CI 0.43-0.88; p = 0.007) and non-procedural major bleeding (OR of 0.46, 95% CI 032-0.65; p < 0.0001). There was no significant difference in all stroke, ischemic stroke, and systemic embolization between the two groups. Conclusions: Our meta-analysis showed lower all-cause mortality, cardiovascular mortality, hemorrhagic stroke, major bleeding, non-procedural major bleeding and the composite of stroke, systemic embolism, and cardiovascular death in the LAAC device arm when compared to OAC. However, the risk of all stroke, ischemic stroke, and systemic embolism were similar between the two arms. (C) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:18 / 24
页数:7
相关论文
共 23 条
[1]   Frequency of de novo atrial fibrillation in patients presenting with acute ischemic cerebrovascular stroke [J].
Abdelnabi, Mahmoud ;
Almaghraby, Abdallah ;
Saleh, Yehia ;
Tok, Ozge ;
oz, Tugba ;
Abdelkarim, Ola ;
Badran, Haitham .
EGYPTIAN HEART JOURNAL, 2020, 72 (01)
[2]   Left Atrial Appendage Occlusion: A Narrative Review [J].
Alsagheir, Ali ;
Koziarz, Alex ;
Belley-Cote, Emilie P. ;
Whitlock, Richard P. .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2019, 33 (06) :1753-1765
[3]   Performance of the subcutaneous implantable cardioverter-defibrillator in patients with a primary prevention indication with and without a reduced ejection fraction versus patients with a secondary prevention indication [J].
Boersma, Lucas V. ;
Barr, Craig S. ;
Burke, Martin C. ;
Leon, Angel R. ;
Theuns, Dominic A. ;
Herre, John M. ;
Weiss, Raul ;
Kremers, Mark S. ;
Neuzil, Petr ;
Husby, Michael P. ;
Carter, Nathan ;
Stivland, Timothy M. ;
Gold, Michael R. .
HEART RHYTHM, 2017, 14 (03) :367-375
[4]  
Camm AJ, 2010, EUR HEART J, V31, P2369, DOI [10.1093/eurheartj/ehq278, 10.1093/europace/euq350]
[5]   Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].
Connolly, Stuart J. ;
Ezekowitz, Michael D. ;
Yusuf, Salim ;
Eikelboom, John ;
Oldgren, Jonas ;
Parekh, Amit ;
Pogue, Janice ;
Reilly, Paul A. ;
Themeles, Ellison ;
Varrone, Jeanne ;
Wang, Susan ;
Alings, Marco ;
Xavier, Denis ;
Zhu, Jun ;
Diaz, Rafael ;
Lewis, Basil S. ;
Darius, Harald ;
Diener, Hans-Christoph ;
Joyner, Campbell D. ;
Wallentin, Lars .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151
[6]   Dabigatran versus Warfarin in Patients with Mechanical Heart Valves [J].
Eikelboom, John W. ;
Connolly, Stuart J. ;
Brueckmann, Martina ;
Granger, Christopher B. ;
Kappetein, Arie P. ;
Mack, Michael J. ;
Blatchford, Jon ;
Devenny, Kevin ;
Friedman, Jeffrey ;
Guiver, Kelly ;
Harper, Ruth ;
Khder, Yasser ;
Lobmeyer, Maximilian T. ;
Maas, Hugo ;
Voigt, Jens-Uwe ;
Simoons, Maarten L. ;
Van de Werf, Frans .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (13) :1206-1214
[7]   EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion - an update [J].
Glikson, Michael ;
Wolff, Rafael ;
Hindricks, Gerhard ;
Mandrola, John ;
Camm, A. John ;
Lip, Gregory Y. H. ;
Fauchier, Laurent ;
Betts, Tim R. ;
Lewalter, Thorsten ;
Saw, Jacqueline ;
Tzikas, Apostolos ;
Sternik, Leonid ;
Nietlispach, Fabian ;
Berti, Sergio ;
Sievert, Horst ;
Bertog, Stefan ;
Meier, Bernhard .
EUROPACE, 2020, 22 (02) :184
[8]   Left atrial appendage closure versus medical therapy in patients with atrial fibrillation: the APPLY study [J].
Gloekler, Steffen ;
Fuerholz, Monika ;
de Marchi, Stefano ;
Kleinecke, Caroline ;
Streit, Samuel R. ;
Buffle, Eric ;
Fankhauser, Mate ;
Haener, Jonas Dominik ;
Nietlispach, Fabian ;
Galea, Roberto ;
Windecker, Stephan ;
Meier, Bernhard .
EUROINTERVENTION, 2020, 16 (09) :E767-+
[9]   Apixaban versus Warfarin in Patients with Atrial Fibrillation [J].
Granger, Christopher B. ;
Alexander, John H. ;
McMurray, John J. V. ;
Lopes, Renato D. ;
Hylek, Elaine M. ;
Hanna, Michael ;
Al-Khalidi, Hussein R. ;
Ansell, Jack ;
Atar, Dan ;
Avezum, Alvaro ;
Cecilia Bahit, M. ;
Diaz, Rafael ;
Easton, J. Donald ;
Ezekowitz, Justin A. ;
Flaker, Greg ;
Garcia, David ;
Geraldes, Margarida ;
Gersh, Bernard J. ;
Golitsyn, Sergey ;
Goto, Shinya ;
Hermosillo, Antonio G. ;
Hohnloser, Stefan H. ;
Horowitz, John ;
Mohan, Puneet ;
Jansky, Petr ;
Lewis, Basil S. ;
Luis Lopez-Sendon, Jose ;
Pais, Prem ;
Parkhomenko, Alexander ;
Verheugt, Freek W. A. ;
Zhu, Jun ;
Wallentin, Lars .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (11) :981-992
[10]   Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial [J].
Holmes, David R. ;
Reddy, Vivek Y. ;
Turi, Zoltan G. ;
Doshi, Shephal K. ;
Sievert, Horst ;
Buchbinder, Maurice ;
Mullin, Christopher M. ;
Sick, Peter .
LANCET, 2009, 374 (9689) :534-542