Paschalis Karakasis: Can Left Atrial Appendage Closure Truly Replace Oral Anticoagulation?
Paschalis Karakasis, Doctor of Philosophy at Aristotle University of Thessaloniki (AUTH), shared a post on LinkedInย about aย recent article he and his colleagues co-authored, published in EP Europace, adding:
“New publication in EP Europace (New IF 10.2)
Can left atrial appendage closure truly replace oral anticoagulation for long-term stroke prevention in atrial fibrillation?
Our new systematic review and meta-analysis brings together the complete randomized evidence from PROTECT AF, PREVAIL, PRAGUE-17, OPTION, CHAMPION-AF, and CLOSURE-AF – six trials including 7,004 patients with up to approximately four years of follow-up.
Key findings:
- LAAC resulted in ๐๐% ๐ก๐ข๐ ๐ก๐๐ซ ๐ซ๐ข๐ฌ๐ค ๐จ๐ ๐ข๐ฌ๐๐ก๐๐๐ฆ๐ข๐ ๐ฌ๐ญ๐ซ๐จ๐ค๐ ๐จ๐ซ ๐ฌ๐ฒ๐ฌ๐ญ๐๐ฆ๐ข๐ ๐๐ฆ๐๐จ๐ฅ๐ข๐ฌ๐ฆ compared with an OAC-based strategy.
- Nonprocedural clinically relevant bleeding was reduced by 50%.
However, LAAC did not significantly reduce major bleeding, haemorrhagic stroke, cardiovascular mortality, or all-cause mortality.
The message is not that LAAC lacks value overall. It is thatย LAAC and anticoagulation are not clinically interchangeable strategies.
Avoiding long-term anticoagulation may reduce nonprocedural bleeding, but this benefit must be weighed against less effective protection from ischaemic thromboembolism.
These data challenge the assumption that freedom from anticoagulation necessarily translates into superior net clinical benefit.ย
Patient selection remains important:ย LAAC should be viewed as a targeted strategy for appropriately selected patients rather than a universal substitute for effective oral anticoagulation.
Perhaps the next question is no longer simply LAAC versus anticoagulation, but whether LAAC combined with carefully selected low-dose DOAC therapy could preserve the reduction in nonprocedural bleeding while mitigating the residual risk of ischaemic thromboembolism – a compelling hypothesis that now warrants dedicated randomized evaluation.”
Title: Long-term efficacy and safety of left atrial appendage closure vs. oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials
Authors: Paschalis Karakasis, Stylianos Tzeis, Athanasios Samaras, Konstantinos Vlachos, Konstantinos Pamporis, Panagiotis Theofilis, Apostolos Tzikas, Antonios P. Antoniadis, Pierre Jaรฏs, Nikolaos Fragakis
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