Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 5: 642 - 647

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.05.014

Evidence-based medicine

Meta-analysis of efficacy and safety of left atrial appendage closure and oral anticoagulants in atrial fibrillation

  • Yan-xia REN ,
  • Zhi-jing AN ,
  • De-mei ZHANG ,
  • Xue-ya GUO
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  • 1.Department of cardiology, the Second Hospital of Lanzhou University, Lanzhou 730000, China
    2.The Second Clinical Medical College of Lanzhou University, Lanzhou 730000, China

Online published: 2021-05-27

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Abstract

Objective

·To evaluate the efficacy and safety of left atrial appendage closure (LAAC) and oral anticoagulants [warfarin and novel oral anticoagulants(NOAC)] in non-valvular atrial fibrillation (AF).

Method

·The related articles were obtained from PubMed, Embase, Cochrane Library, Wanfang database and CNKI, from the establishment of databases to July 2020. English retrieval method was as follows: ("atrial fibrillation" or "AF" or "nonvalvular AF") and ("left atrial appendage closure" or "LAAC") and ("new oral anticoagulants" or "NOAC" or "novel oral anticoagulants" or "non-vitamin K antagonist oral anticoagulants" or "warfarin"). Chinese keywords were "心房颤动""左心耳封堵术""新型口服抗凝剂" and "华法林". The articles were screened according to inclusion and exclusion criterias, and the quality evaluation and data extraction were carried out. The RevMan 5.3 software was used for meta-analysis of the data. The primary efficacy and safety endpoints were the incidence of embolism events, bleeding events, all-cause mortality events and sudden cardiac death (SCD).

Results

·Finally, nine articles was included, including three randomized controlled trials and six non-randomized controlled trials, consisting of 2 429 patients. The result of meta-analysis showed that there was no significant difference in compound embolism events in patients with AF treated with LAAC, compared with oral anticoagulant therapy (OR=0.90, 95%CI 0.62?1.31, P=0.59). There was no significant difference in all-cause mortality events in patients with AF treated with LAAC, compared with oral anticoagulant therapy (OR=1.11, 95%CI 0.48?2.59, P=0.81). There was no significant difference in SCD patients with AF treated with LAAC, compared with oral anticoagulant therapy (OR=0.90,95%CI 0.38?2.11, P=0.81). Compared with warfarin and NOAC, the incidence of bleeding events in patients treated with LAAC was decreased significantly (OR=0.48, 95%CI 0.35?0.65, P=0.000).

Conclusion

·There is no significant difference in embolism and death in patients of non-valvular AF treated with LAAC, compared with oral anticoagulants. But it has a lower risk of bleeding.

Key words： atrial fibrillation (AF); left atrial appendage closure (LAAC); novel oral anticoagulant (NOAC); warfarin

Cite this article

Yan-xia REN , Zhi-jing AN , De-mei ZHANG , Xue-ya GUO . Meta-analysis of efficacy and safety of left atrial appendage closure and oral anticoagulants in atrial fibrillation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(5) : 642 -647 . DOI: 10.3969/j.issn.1674-8115.2021.05.014

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