TY - JOUR
T1 - Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants in atrial fibrillation
AU - Ding, Wern Yew
AU - Rivera-Caravaca, José Miguel
AU - Fazio-Eynullayeva, Elnara
AU - Underhill, Paula
AU - Gupta, Dhiraj
AU - Marín, Francisco
AU - Lip, Gregory Y. H.
N1 - © 2022. The Author(s).
PY - 2022/9
Y1 - 2022/9
N2 - 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. Graphical abstract: [Figure not available: see fulltext.]
AB - 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. Graphical abstract: [Figure not available: see fulltext.]
KW - All-cause mortality
KW - Atrial fibrillation
KW - Left atrial appendage occlusion
KW - Non-vitamin K antagonist oral anticoagulant
KW - Outcome
KW - Thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85122663416&partnerID=8YFLogxK
U2 - 10.1007/s00392-021-01983-z
DO - 10.1007/s00392-021-01983-z
M3 - Journal article
C2 - 34994832
SN - 1861-0684
VL - 111
SP - 1040
EP - 1047
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 9
ER -