Left Atrial Appendage Occlusion vs. Oral Anticoagulants: Current Evidence and Debates
Journal of Clinical Medicine, cilt.15, sa.18, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 15 Sayı: 18
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcm15187015
- Dergi Adı: Journal of Clinical Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, EMBASE, Academic Search Ultimate (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: antithrombotic therapy, atrial fibrillation, device-related thrombus, direct oral anticoagulants, left atrial appendage occlusion, peridevice leak, stroke prevention
- Ankara Üniversitesi Adresli: Evet
Özet
Atrial fibrillation (AF) is a major cause of cardioembolic stroke, and oral anticoagulation (OAC) remains the standard of care for thromboembolic prophylaxis. Because the left atrial appendage (LAA) is the dominant source of thrombus in AF, percutaneous LAA occlusion (LAAO) has been developed as a mechanical alternative for patients in whom long-term anticoagulation is problematic. Randomized trials against warfarin established non-inferiority for the composite endpoint, though not consistently across coprimary endpoints, and more recent trials against direct oral anticoagulants (DOACs) have extended this comparison to post-ablation and lower-risk populations. Across these studies a consistent pattern emerges: the clinical advantage of LAAO derives largely from a reduction in non-procedural bleeding rather than from superior ischemic protection, and recent meta-analyses diverge mainly according to how the thromboembolic endpoint is composed. At the extreme of stroke and bleeding risk, LAAO failed to demonstrate non-inferiority to physician-directed medical care. This review synthesizes the randomized evidence, examines methodological differences in endpoint construction and patient selection that complicate cross-trial comparison, and discusses determinants of procedural success including peridevice leak, device endothelialization, and device-related thrombus. Remaining evidence gaps are outlined, particularly for patients who experience ischemic stroke despite adequate anticoagulation.