TY  - JOUR
A1  - Chen, Shaojie
A1  - Chun, Kyoung-Ryul Julian
A1  - Ling, Zhiyu
A1  - Liu, Shaowen
A1  - Zhu, Lin
A1  - Wang, Jiazhi
A1  - Schratter, Alexandra
A1  - Acou, Willem-Jan
A1  - Kiuchi, Márcio Galindo
A1  - Yin, Yuehui
A1  - Schmidt, Boris
T1  - Comparison of left atrial appendage occlusion versus non-vitamin-K antagonist oral anticoagulation in high-risk atrial fibrillation: an update
T2  - Journal of cardiovascular development and disease
N2  - Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64–1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to “contemporary NOACs”. The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.
KW  - atrial fibrillation
KW  - left atrial appendage occlusion
KW  - stroke
KW  - anticoagulation
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62170
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-621706
SN  - 2308-3425
VL  - 8
IS  - 6, art. 69
SP  - 1
EP  - 9
PB  - MDPI AG
CY  - Basel
ER  -