Is percutaneous closure of the left atrial appendage comparable to anticoagulants for atrial fibrillation?

Abstract

For most atrial fibrillation patients oral anticoagulation constitutes the standard treatment to prevent stroke. However, they carry a risk of bleeding, which is why alternative treatments have been put into practice, such as percutaneous closure of the left atrial appendage. It is not clear whether this is as effective as the conventional treatment with anticoagulants. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including only one pertinent randomized controlled trial. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded that percutaneous left atrial appendage occlusion may decrease stroke and mortality, but the certainty of the evidence is low. The effect on other outcomes is not clear because the certainty of the evidence is very low.

Posicionamiento conjunto acerca del tratamiento para fibrilación auricular

“…Markov's stochastic decision model) have yielded contradictory results 57 . However, several studies are ongoing and are expected to produce positive results for occluders 58 . Like any invasive procedure, its efficacy in preventing stoke should weigh against possible complications of its implant.…”