+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials



Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials



Journal of Cardiovascular Surgery 59(1): 128-139



Atrial fibrillation (AF) is one of the leading causes of stroke. Risks associated with oral anticoagulation (OAC) limit adherence to recommended therapy. Left atrial appendage (LAA) occlusion is a treatment alternative in patients with AF. We performed a network meta-analysis (NMA) of randomized trials evaluating the efficacy of LAA occlusion compared with oral anticoagulant, antiplatelet, and placebo for stroke prevention. We also assessed the impact of LAA occlusion on mortality, major bleeding, and operative time. We searched MEDLINE, EMBASE, PubMed, and Cochrane Library for randomized trials comparing percutaneous or surgical LAA occlusion with standard of care in AF patients. Conventional meta-analysis found no difference between groups for stroke (5 trials, 1285 patients;RR 0.78, 95% CI 0.47-1.29), and a significant reduction in mortality (5 trials, 1285 patients; RR 0.71, 95% CI 0.51-0.99) favouring LAA occlusion. NMA demonstrated a trend towards reduction in stroke (OR 0.84, 95% CrI 0.47-1.55) and mortality (OR 0.69, 95% CrI 0.44-1.10) for LAA occlusion versus warfarin, but no statistically significant effect. Statistical ranking curves placed LAA occlusion as the most efficacious treatment on the outcomes of stroke and mortality when compared to warfarin, aspirin, or placebo. No significant differences between groups were seen in major bleeding or operative time for surgical trials. The overall quality of the evidence was low as assessed by GRADE. LAA occlusion appears to preserve the benefits of OAC therapy for stroke prevention in patients with AF, but the current evidence is of low quality.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059912702

Download citation: RISBibTeXText

PMID: 28215062

DOI: 10.23736/s0021-9509.17.09824-x


Related references

Left Atrial Appendage Occlusion For Stroke Prevention In Patients With Atrial Fibrillation - A Systematic Review And Network Meta-Analysis Of Randomized Controlled Trials. Canadian Journal of Cardiology 31(10): S217-S218, 2015

Left Atrial Appendage Occlusion Device and Novel Oral Anticoagulants Versus Warfarin for Stroke Prevention in Nonvalvular Atrial Fibrillation: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circulation. Arrhythmia and Electrophysiology 8(5): 1057-1064, 2015

Over 1-year efficacy and safety of left atrial appendage occlusion versus novel oral anticoagulants for stroke prevention in atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials and observational studies. Heart Rhythm 13(6): 1203-1214, 2016

Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review. Heart Failure Reviews 23(2): 191-208, 2018

Left atrial appendage occlusion for prevention of stroke in nonvalvular atrial fibrillation: a meta-analysis. Journal of Interventional Cardiac Electrophysiology 43(1): 79-89, 2015

Percutaneous atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review. Heart 98(12): 900-907, 2012

Efficacy and Safety of Percutaneous Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation: A Meta-analysis of Contemporary Studies. Heart Lung and Circulation 25(11): 1107-1117, 2016

Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal. Journal of Stroke 20(3): 281-291, 2018

Cardiac MRI for detecting left atrial/left atrial appendage thrombus in patients with atrial fibrillation : Meta-analysis and systematic review. Herz 44(5): 390-397, 2019

Interatrial septum versus right atrial appendage pacing for prevention of atrial fibrillation : A meta-analysis of randomized controlled trials. Herz 43(5): 438-446, 2018

Percutaneous left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: a systematic review and analysis of observational studies. Jacc. Cardiovascular Interventions 7(3): 296-304, 2014

Quality of life assessment in the randomized PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) trial of patients at risk for stroke with nonvalvular atrial fibrillation. Journal of the American College of Cardiology 61(17): 1790-1798, 2013

Left atrial appendage occlusion in atrial fibrillation for stroke prevention: A systemic review. International Journal of Cardiology 203: 55-59, 2016

A Decision Analysis of Percutaneous Left Atrial Appendage Occlusion Relative to Novel and Traditional Oral Anticoagulation for Stroke Prevention in Patients with New-Onset Atrial Fibrillation. Medical Decision Making 36(3): 366-374, 2016

Stroke Event Rates and the Optimal Antithrombotic Choice of Patients With Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine 94(52): E2364, 2015