{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:35:39Z","timestamp":1793216139877,"version":"4.5.0"},"reference-count":39,"publisher":"Elsevier BV","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Advances"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.jacadv.2026.103269","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:16:34Z","timestamp":1790198194000},"page":"103269","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"P2","title":["Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation"],"prefix":"10.1016","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5934-6651","authenticated-orcid":false,"given":"Yuriko","family":"Hiruma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-0176","authenticated-orcid":false,"given":"Tadao","family":"Aikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwanari","family":"Kawamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masao","family":"Iwagami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polydoros","family":"Kampaktsis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Briasoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Fatehi","family":"Hassanabad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaveh","family":"Hosseini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0561-4760","authenticated-orcid":false,"given":"Pier Pasquale","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3091-3735","authenticated-orcid":false,"given":"Leandro","family":"Slipczuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Wiley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Secemsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-3779","authenticated-orcid":false,"given":"Roger","family":"Laham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Kuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.jacadv.2026.103269_bib1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","article-title":"Epidemiology of atrial fibrillation in the 21st century","volume":"127","author":"Kornej","year":"2020","journal-title":"Circ Res"},{"issue":"16","key":"10.1016\/j.jacadv.2026.103269_bib2","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.jacc.2024.07.014","article-title":"Minimum national prevalence of diagnosed atrial fibrillation inferred from California acute care facilities","volume":"84","author":"Noubiap","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"10.1016\/j.jacadv.2026.103269_bib3","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1161\/CIRCULATIONAHA.116.024057","article-title":"Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation","volume":"135","author":"Quinn","year":"2017","journal-title":"Circulation"},{"issue":"36","key":"10.1016\/j.jacadv.2026.103269_bib4","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"issue":"1","key":"10.1016\/j.jacadv.2026.103269_bib5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jacc.2023.08.017","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"83","author":"Joglar","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"10.1016\/j.jacadv.2026.103269_bib6","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.jacc.2020.04.053","article-title":"2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants","volume":"76","author":"Tomaselli","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"10.1016\/j.jacadv.2026.103269_bib7","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann Thorac Surg"},{"issue":"11","key":"10.1016\/j.jacadv.2026.103269_bib8","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jacc.2008.03.067","article-title":"Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography","volume":"52","author":"Kanderian","year":"2008","journal-title":"J Am Coll Cardiol"},{"issue":"25","key":"10.1016\/j.jacadv.2026.103269_bib9","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1016\/j.jacc.2013.03.035","article-title":"Left atrial appendage closure with the watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA plavix feasibility study with watchman left atrial appendage closure technology)","volume":"61","author":"Reddy","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacadv.2026.103269_bib10","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-074495","article-title":"A guide and pragmatic considerations for applying GRADE to network meta-analysis","volume":"381","author":"Izcovich","year":"2023","journal-title":"BMJ"},{"issue":"6","key":"10.1016\/j.jacadv.2026.103269_bib11","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1097\/EDE.0000000000000733","article-title":"On a square-root transformation of the odds ratio for a common outcome","volume":"28","author":"VanderWeele","year":"2017","journal-title":"Epidemiology"},{"key":"10.1016\/j.jacadv.2026.103269_bib12","doi-asserted-by":"crossref","first-page":"610","DOI":"10.12688\/f1000research.14770.1","article-title":"Estimating the contribution of studies in network meta-analysis: paths, flows and streams","volume":"7","author":"Papakonstantinou","year":"2018","journal-title":"F1000Res"},{"issue":"11","key":"10.1016\/j.jacadv.2026.103269_bib13","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.jacc.2024.10.101","article-title":"5-Year results from the AMPLATZER amulet left atrial appendage occluder randomized controlled trial","volume":"85","author":"Lakkireddy","year":"2025","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"10.1016\/j.jacadv.2026.103269_bib14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jacc.2025.03.535","article-title":"3-Year clinical outcomes comparing the amulet vs watchman FLX for left atrial appendage closure in patients with atrial fibrillation","volume":"86","author":"Galea","year":"2025","journal-title":"J Am Coll Cardiol"},{"issue":"13","key":"10.1016\/j.jacadv.2026.103269_bib15","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2408308","article-title":"Left atrial appendage closure after ablation for atrial fibrillation","volume":"392","author":"Wazni","year":"2025","journal-title":"N Engl J Med"},{"issue":"1","key":"10.1016\/j.jacadv.2026.103269_bib16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2021.10.023","article-title":"4-Year outcomes after left atrial appendage closure vs nonwarfarin oral anticoagulation for atrial fibrillation","volume":"79","author":"Osmancik","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"24","key":"10.1016\/j.jacadv.2026.103269_bib17","doi-asserted-by":"crossref","first-page":"2964","DOI":"10.1016\/j.jacc.2017.10.021","article-title":"5-Year outcomes after left atrial appendage closure","volume":"70","author":"Reddy","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"22","key":"10.1016\/j.jacadv.2026.103269_bib18","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban vs warfarin in patients with atrial fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N Engl J Med"},{"issue":"10","key":"10.1016\/j.jacadv.2026.103269_bib19","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban vs warfarin in nonvalvular atrial fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N Engl J Med"},{"issue":"11","key":"10.1016\/j.jacadv.2026.103269_bib20","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban vs warfarin in patients with atrial fibrillation","volume":"365","author":"Granger","year":"2011","journal-title":"N Engl J Med"},{"issue":"13","key":"10.1016\/j.jacadv.2026.103269_bib21","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1056\/NEJMoa2513310","article-title":"Left atrial appendage closure or medical therapy in atrial fibrillation","volume":"394","author":"Landmesser","year":"2026","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacadv.2026.103269_bib22","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMoa2517213","article-title":"Left atrial appendage closure or anticoagulation for atrial fibrillation","author":"Doshi","year":"2026","journal-title":"N Engl J Med"},{"issue":"12","key":"10.1016\/j.jacadv.2026.103269_bib23","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran vs warfarin in patients with atrial fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N Engl J Med"},{"issue":"7","key":"10.1016\/j.jacadv.2026.103269_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacadv.2026.102933","article-title":"Left atrial appendage closure vs direct oral anticoagulants in atrial fibrillation: meta-analysis of randomized trials","volume":"5","author":"Chan","year":"2026","journal-title":"JACC Adv"},{"issue":"3","key":"10.1016\/j.jacadv.2026.103269_bib25","doi-asserted-by":"crossref","DOI":"10.1002\/joa3.70382","article-title":"Left atrial appendage closure vs. oral anticoagulation in patients with atrial fibrillation: an updated systematic review and meta-analysis of randomized controlled trials","volume":"42","author":"Chilaka","year":"2026","journal-title":"J Arrhythm"},{"issue":"9","key":"10.1016\/j.jacadv.2026.103269_bib26","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.jcin.2026.02.016","article-title":"1-Year real-world outcomes with the amulet occluder from the EMERGE LAA postapproval study","volume":"19","author":"Lakkireddy","year":"2026","journal-title":"JACC Cardiovasc Interv"},{"issue":"9","key":"10.1016\/j.jacadv.2026.103269_bib27","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.123.013750","article-title":"Outcomes with the WATCHMAN FLX in everyday clinical practice from the NCDR left atrial appendage occlusion registry","volume":"17","author":"Kapadia","year":"2024","journal-title":"Circ Cardiovasc Interv"},{"issue":"9","key":"10.1016\/j.jacadv.2026.103269_bib28","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1161\/CIRCULATIONAHA.118.035090","article-title":"Device-related thrombus after left atrial appendage closure","volume":"138","author":"Dukkipati","year":"2018","journal-title":"Circulation"},{"issue":"4","key":"10.1016\/j.jacadv.2026.103269_bib29","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1161\/STROKEAHA.122.041057","article-title":"Early stroke and mortality after percutaneous left atrial appendage occlusion in patients with atrial fibrillation","volume":"54","author":"Kogan","year":"2023","journal-title":"Stroke"},{"issue":"2","key":"10.1016\/j.jacadv.2026.103269_bib30","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jacep.2023.10.012","article-title":"Severity of ischemic stroke after left atrial appendage closure vs nonwarfarin oral anticoagulants","volume":"10","author":"Turagam","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"issue":"12","key":"10.1016\/j.jacadv.2026.103269_bib31","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.49017","article-title":"Risk of intracranial hemorrhage associated with direct oral anticoagulation vs antiplatelet therapy: a systematic review and meta-analysis","volume":"7","author":"Coyle","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"10.1016\/j.jacadv.2026.103269_bib32","first-page":"62","article-title":"The watchman FLX \u2013 a new device for left atrial appendage occlusion \u2013 design, potential benefits and first clinical experience","volume":"13","author":"Grygier","year":"2017","journal-title":"Post\u0119py Kardiol Interwencyjnej"},{"issue":"9","key":"10.1016\/j.jacadv.2026.103269_bib33","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1093\/europace\/euac021","article-title":"Watchman FLX vs watchman 2.5 in a dual-center left atrial appendage closure cohort: the WATCH-DUAL study","volume":"24","author":"Galea","year":"2022","journal-title":"Europace"},{"issue":"7","key":"10.1016\/j.jacadv.2026.103269_bib34","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.jacep.2025.02.016","article-title":"Characterization and clinical outcomes of high-risk device-related thrombus in the amulet IDE trial","volume":"11","author":"Nielsen-Kudsk","year":"2025","journal-title":"JACC Clin Electrophysiol"},{"issue":"10","key":"10.1016\/j.jacadv.2026.103269_bib35","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.jacc.2024.05.067","article-title":"Anticoagulation alone vs anticoagulation plus aspirin or DAPT following left atrial appendage occlusion","volume":"84","author":"Reinhardt","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"7","key":"10.1016\/j.jacadv.2026.103269_bib36","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.119.008481","article-title":"Reduced rivaroxaban dose vs dual antiplatelet therapy after left atrial appendage closure: ADRIFT a randomized pilot study","volume":"13","author":"Duthoit","year":"2020","journal-title":"Circ Cardiovasc Interv"},{"issue":"9","key":"10.1016\/j.jacadv.2026.103269_bib37","article-title":"2025 SCAI\/HRS clinical practice guidelines on transcatheter left atrial appendage occlusion","volume":"4","author":"Goldsweig","year":"2025","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"issue":"8","key":"10.1016\/j.jacadv.2026.103269_bib38","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.125.018151","article-title":"Cardiac CT vs transesophageal echocardiography following left atrial appendage closure: a systematic review and meta-analysis","volume":"18","author":"Tan","year":"2025","journal-title":"Circ Cardiovasc Imaging"},{"issue":"22","key":"10.1016\/j.jacadv.2026.103269_bib39","doi-asserted-by":"crossref","first-page":"2695","DOI":"10.1016\/j.jcin.2023.10.046","article-title":"Device-related thrombus after left atrial appendage occlusion: clinical impact, predictors, classification, and management","volume":"16","author":"Alkhouli","year":"2023","journal-title":"JACC Cardiovasc Interv"}],"container-title":["JACC: Advances"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X26006903?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X26006903?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:26:40Z","timestamp":1793215600000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2772963X26006903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":39,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["S2772963X26006903"],"URL":"https:\/\/doi.org\/10.1016\/j.jacadv.2026.103269","relation":{},"ISSN":["2772-963X"],"issn-type":[{"value":"2772-963X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Left Atrial Appendage Occlusion vs Direct Oral Anticoagulants for Atrial Fibrillation","name":"articletitle","label":"Article Title"},{"value":"JACC: Advances","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacadv.2026.103269","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.","name":"copyright","label":"Copyright"}],"article-number":"103269"}}