{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:31:42Z","timestamp":1792794702709,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Atrial fibrillation\u2010related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and network meta\u2010analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all\u2010cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 476 articles identified from the search and 6 eligible RCTs were included (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093666). There was no difference in the risk of stroke with Amulet versus Watchman (RR\u2009=\u20091.48, 95% CI: 0.64\u20133.46,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200941.3%), nor in the risk of death (RR\u2009=\u20091.00, 95% CI: 0.59\u20131.70,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200945.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR\u2009=\u20090.73, 95% CI: 0.18\u20132.97,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), nor was risk of device embolization (RR\u2009=\u20092.29, 95% CI: 0.71, 7.43,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR\u2009=\u200927.08, 95% CI: 3.53\u2013207.98,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%) followed by Watchman (RR\u2009=\u200912.79, 95% CI: 1.73\u201394.85,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR\u2009=\u20092.12, 95% CI: 1.45\u20133.09).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70217","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T23:41:02Z","timestamp":1763854862000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8137-0323","authenticated-orcid":false,"given":"John W.","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Washington University in St. Louis\/Barnes\u2010Jewish Hospital St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L.","family":"Mai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas Medical Branch at Galveston Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wissam","family":"Harmouch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas Medical Branch at Galveston Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Reisler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas Medical Branch at Galveston Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"MacKay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Washington University in St. Louis\/Barnes\u2010Jewish Hospital St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiovascular Medicine University of Texas Medical Branch at Galveston Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0482-4448","authenticated-orcid":false,"given":"Pavel","family":"Osmancik","sequence":"additional","affiliation":[{"name":"University Hospital Kralovske Vinohrady Charles University Prague Czechia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4243-9391","authenticated-orcid":false,"given":"Michael W.","family":"Rich","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Washington University in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00277-6"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.029259"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2016.06.006"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029616675970"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.057063"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(95)00134-4"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61343-X"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.057063"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-043714"},{"key":"e_1_2_9_12_1","unstructured":"G.R\u00fccker U.Krahn J.K\u00f6nig O.Efthimiou andG.Schwarzer \u201cnetmeta: Network Meta\u2010Analysis Using Frequentist Methods \u201d January 18 2021 https:\/\/CRAN.R-project.org\/package=netmeta."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","unstructured":"J. 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