Hilaryano Ferreira: Presented Our Meta-Analysis of LAAC Versus Oral Anticoagulation at ESC Congress
Hilaryano Ferreira, BLS Instructor at American Heart Association and American Stroke Association, Cardiologist at ULS Santa Maria, shared a post on LinkedIn:
“On Monday I presented our meta-analysis of left atrial appendage closure versus oral anticoagulation at ESC Congress in Munich.
Four randomised trials, 3,116 patients, spanning warfarin to contemporary DOACs. The efficacy signal was consistent across all of them (RR 0.79, I² 6%). The safety signal was not (I² 86%), and that heterogeneity is the finding, not the noise. It tracks the comparator era and how bleeding was defined.
Isolate the DOAC-era, post-ablation population in OPTION and LAAC cuts non-procedural bleeding at 36 months by more than half. Pool everything into one composite and that disappears.
Net clinical benefit is real. It is also context-dependent, and a single pooled endpoint hides more than it shows. CHAMPION-AF made the same point at scale: clearly less long-term bleeding, but a front-loaded procedural cost that has to be part of the conversation.
That same day I sat in on Dr Desiree Wussler talk, ‘Left atrial appendage occlusion after the hype: where are we?’ It was the clearest framing of the field I have heard.
CHAMPION-AF, the trials still running, the shift toward minimalist procedures, and an honest landing point: this is now a shared decision, not a fallback for patients who cannot take anticoagulation. That kind of synthesis is what clinicians need and rarely get.
I left Munich with more questions than I brought, and a clearer sense of where I want to spend the next few years answering them. If your centre is working on these, I would like to hear about it.
Thank you to my co-authors.”
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