Latest outcomes of transcatheter left atrial appendage closure devices and direct oral anticoagulant therapy in patients with atrial fibrillation over the past 5  years: a systematic review and meta-analysis

AbstractLeft atrial appendage closure (LAAC) are emerging treatment for patients with atrial fibrillation (AF). However, data on the safety, efficacy, and medications for LAAC devices in patients with AF are lacking. We aimed to investigate the incidence of all-cause mortality, stroke, and major bleeding in AF patients with LAAC devices and DOACs. Moreover, we aimed to investigate the incidence rate of device-related thrombus (DRT) and the medications used in the management of AF patients with LAAC devices to gain insights into achieving better outcome. Based on a literature search using PubMed, EMBASE, Cochrane Library, and Web of Science databases between January 2015 and December 2020, eight LAAC device studies that used WATCHMAN and Amulet, and three DOAC studies that used rivaroxaban, with a total of 24,055 AF patients (LAAC devices,n = 2855; DOAC,n = 21,200), were included. A random-effects model was used to incorporate heterogeneity among studies. The pooled incidence of events per person-years were as follows: all-cause mortality, 0.06 (95% confidence interval [CI] 0.02–0.10) for WATCHMAN, 0.04 (95% CI 0.00–0.14) for Amulet, and 0.0 3 (95% CI 0.01–0.04) for rivaroxaban; stroke; 0.02 (95% CI 0.00–0.04) for WATCHMAN, 0 for Amulet, and 0.01 (95% CI 0.01–0.02) for rivaroxaban; major bleeding, 0.04 (95% CI 0.02–0.06) for WATCHMAN, 0.02 (95% CI 0.00–0.06) for Amulet, and 0.02 (95% CI 0.01–0.03) for rivaroxaban. The incide nce rate of DRT was 2.3%, an...
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research