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 LinkedInΒ about aΒ 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 ππ% π‘π’π π‘ππ« π«π’π¬π€ π¨π π’π¬ππ‘πππ¦π’π π¬ππ«π¨π€π π¨π« π¬π²π¬πππ¦π’π ππ¦ππ¨π₯π’π¬π¦ 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 thatΒ 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.Β
Patient selection remains important:Β 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 JaΓ―s, Nikolaos Fragakis
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