Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants in atrial fibrillation.

Abstract

BACKGROUND:

The effects of left atrial appendage (LAA) occlusion compared to non-vitamin K antagonist oral anticoagulant (NOAC) therapy in patients with atrial fibrillation (AF) remain unknown.

AIMS:

We aimed to evaluate the outcomes in patients with AF who received LAA occlusion vs. NOAC therapy.

METHODS:

We utilised data from TriNetX which is a global federated health research network currently containing data for 88.5 million patients. ICD-10 codes were employed to identify AF patients treated with either LAA occlusion or NOAC between 1st December 2010 and 17th January 2019. Clinical outcomes of interest were analysed up to 2 years.

RESULTS:

108,697 patients were included. Patients who underwent LAA occlusion were younger, more likely to be white Caucasian and male, had a greater incidence of comorbidities, and were less likely to be prescribed other cardiovascular medications. Using propensity score matching, the risk of all-cause mortality was significantly lower among patients who received LAA occlusion compared to NOAC therapy [1.51% vs. 5.60%, RR 0.27 (95% CI 0.14-0.54)], but there were no statistical differences in the composite thrombotic or thromboembolic events [8.17% vs. 7.72%, RR 1.06 (95% CI 0.73-1.53)], ischaemic stroke or TIA [4.69% vs. 5.45%, RR 0.86 (95% CI 0.54-1.38)], venous thromboembolism [1.66% vs. 1.51%, RR 1.10 (95% CI 0.47-2.57)] and intracranial haemorrhage [1.51% vs. 1.51%, RR 1.00 (95% CI 0.42-2.39)].

CONCLUSION:

Overall, LAA occlusion might be a suitable alternative to NOAC therapy for stroke prevention in patients with AF.

• Authors: Wern Yew Ding, José Miguel Rivera-Caravaca, Elnara Fazio-Eynullayeva, Paula Underhill, Dhiraj Gupta, Francisco Marín, Gregory Y H Lip
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 111 Issue 9 Pg. 1040-1047 (Sep 2022) ISSN: 1861-0692 [Electronic] Germany
• PMID: 34994832 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Anticoagulants

Topics

• Anticoagulants
• Atrial Appendage (surgery)
• Atrial Fibrillation (complications, drug therapy, surgery)
• Brain Ischemia
• Humans
• Male
• Stroke (epidemiology, etiology, prevention & control)
• Treatment Outcome