Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia.
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Trends Cardiovasc Med. 2024 May;34(4):225-233. doi: 10.1016/j.tcm.2023.02.002. Epub 2023 Feb 10.
Left atrial appendage occlusion (LAAO) was found to be non-inferior to warfarin. In non-valvular atrial fibrillation (AF), there is still a scarcity of data comparing LAAO versus non-vitamin K oral anticoagulants (NOACs). Our purpose was to compare the clinical benefits between LAAO and NOACs in non-valvular AF patients. The patient, intervention, comparison, and outcome principles were used to develop the research question in this systematic review and meta-analysis. Literature searches were conducted in online scientific databases such as ProQuest, PubMed, and ScienceDirect. All important information was extracted. The random-effect model was applied to estimate all pooled effects. The Mantel-Haenszel statistical method was used to determine the pooled risk ratio (RR) and 95% confidence interval (CI). A total of 4411 participants from 5 studies were involved. LAAO significantly decreased the cardiovascular mortality risk compared to NOACs (RR = 0.56; 95% CI = 0.42 to 0.75; p <0.01). Major bleeding risk in the LAAO group was significantly lower than in the NOACs group (RR = 0.66; RR = 0.53 to 0.82; p <0.01). A significantly lower risk of major bleeding or non-major bleeding in the patients receiving LAAO than NOACs was also observed in this meta-analysis (RR = 0.66; 95% CI = 0.54 to 0.81; p <0.01). LAAO was superior to the NOACs in reducing cardiovascular mortality, major bleeding, and major or non-major bleeding risks in non-valvular AF patients. In high-risk thromboembolism and bleeding patients, LAAO can be considered first as a long-term treatment strategy.
左心耳封堵术（LAAO）被发现并不逊于华法林。在非瓣膜性心房颤动（AF）中，比较 LAAO 与非维生素 K 口服抗凝剂（NOACs）的数据仍然很少。我们的目的是比较 LAAO 与非瓣膜性 AF 患者的 NOACs 的临床获益。本系统评价和荟萃分析采用患者、干预、比较和结局原则制定研究问题。文献检索在 ProQuest、PubMed 和 ScienceDirect 等在线科学数据库中进行。提取所有重要信息。应用随机效应模型估计所有汇总效应。Mantel-Haenszel 统计方法用于确定汇总风险比（RR）和 95%置信区间（CI）。共有 5 项研究的 4411 名患者参与。与 NOACs 相比，LAAO 显著降低心血管死亡率风险（RR=0.56；95%CI=0.42 至 0.75；p<0.01）。LAAO 组的大出血风险显著低于 NOACs 组（RR=0.66；95%CI=0.53 至 0.82；p<0.01）。荟萃分析还观察到，LAAO 组患者大出血或非大出血的主要出血风险也明显低于 NOACs 组（RR=0.66；95%CI=0.54 至 0.81；p<0.01）。在非瓣膜性 AF 患者中，LAAO 在降低心血管死亡率、大出血和主要或非主要出血风险方面优于 NOACs。在高血栓栓塞和出血风险患者中，LAAO 可作为一种长期治疗策略首先考虑。
