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Título

Revisiting left atrial appendage closure versus oral anticoagulants in recurrent atrial fibrillation management: an updated systematic review and meta-analysis

Resumo

Introduction: Atrial fibrillation (AF) is a significant public health problem globally due to its association with coronary heart disease, stroke, and mortality, especially in the elderly, making the prevention of stroke a necessity. Therefore, traditional warfarin therapy, direct oral anticoagulants (DOACs), and the left atrial appendage closure (LAAC) have been compared as treatment approaches. In this regard, we aimed to synthesize the current evidence regarding the comparison of LAAC and DOACs in patients with AF.
Methods: We followed the PRISMA statement guidelines when reporting this updated systematic review and meta-analysis. All steps were done in strict accordance with the Cochrane Handbook of Systematic Reviews and Meta-analysis of Interventions (version 5.1.0). We compared the safety and efficacy of LAAC and DOACs in patients with AF in terms of the composite outcome of stroke, systemic embolism and cardiovascular death, all-cause mortality, ischemic stroke and thromboembolic events, ischemic stroke, major bleeding, cardiovascular mortality, and hospital stay duration. An updated meta-analysis was conducted using fixed and random-effect models to calculate odds ratios (OR) or mean difference (MD) with 95% confidence intervals (CIs) for the dichotomous and continuous outcomes, respectively.
Results: Eleven studies were eligible that included a total of 68171 patients. Compared to DOACs, the LAAC group was associated with a lower rate of hospital stay duration (MD: -1.23; 95%CI: -1.51 to -0.95, p < 0.001). There was no statistically significant difference between LAAC and DOACs in terms of the composite outcome of stroke, systemic embolism and cardiovascular death (OR: 1.45; 95%CI: 0.81-11.55; p = 0.72), all-cause mortality (OR: 1.03; 95%CI: 0.13-8.54; p = 0.97), ischemic stroke and thromboembolic events (OR: 2.53; 95%CI: 0.23-27.36; p = 0.44), ischemic stroke (OR: 0.99; 95%CI: 0.75-1.32; p = 0.96), major bleeding (OR: 1.28; 95%CI: 0.16-10.46; p = 0.82), and cardiovascular mortality (OR: 0.83, 95%CI: 0.27 - 2.48; p = 0.73).
Conclusion: Our meta-analysis showed a lower rate of hospital stay duration that favors LAAC; however, the risk of composite outcome of stroke, systemic embolism and cardiovascular death, all-cause mortality, ischemic stroke and thromboembolic events, ischemic stroke, major bleeding, and cardiovascular mortality were similar between the two treatment groups.

Palavras Chave

atrial fibrillation; left atrial appendage closure; direct oral anticoagulants

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