{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:43:14Z","timestamp":1789486994614,"version":"build-2803163510"},"reference-count":4,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Landmark randomized controlled trials (RCTs) comparing left atrial appendage occlusion (LAAO) against direct oral anticoagulants (DOACs) are individually underpowered for small but clinically meaningful differences. We performed a pooled meta\u2010analysis to provide more precise efficacy and safety data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Utilizing random\u2010effects models, we pooled data from 5890 patients across four landmark RCTs (PRAGUE\u201017, CLOSURE\u2010AF, OPTION, and CHAMPION\u2010AF) at their longest follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were no significant differences between LAAO and antithrombotics in cardiovascular mortality (5.3% vs. 4.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.33), all\u2010cause stroke (3.3% vs. 2.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31), systemic embolism (0.2% vs. 0.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.68), or major bleeding (6.6% vs. 6.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.85). Non\u2010procedural bleeding was significantly lower with LAAO (9.2% vs. 16.7%; RR 0.55; 95% CI 0.47\u20130.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), though there was a numerical trend toward more ischemic stroke events (2.7% vs. 2.0%; RR 1.35; 95% CI 0.97\u20131.88;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAAO offers similar overall efficacy and safety to modern antithrombotics. It represents a clinical trade\u2010off: accepting a known upfront procedural risk for a robust, long\u2010term reduction in non\u2010procedural bleeding, potentially at the cost of a slight numerical increase in ischemic stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70493","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:50:58Z","timestamp":1788501058000},"page":"2122-2123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pooled Efficacy and Safety of Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants or Antiplatelets: A Meta\u2010Analysis of the Landmark Randomized Trials"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9690-2866","authenticated-orcid":false,"given":"Leonardo M.","family":"Knijnik","sequence":"first","affiliation":[{"name":"Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-8533","authenticated-orcid":false,"given":"Birju","family":"Rao","sequence":"additional","affiliation":[{"name":"Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"DeLurgio","sequence":"additional","affiliation":[{"name":"Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.067"},{"key":"e_1_2_4_3_1","first-page":"1102","article-title":"Left Atrial Appendage Closure Versus Non\u2010Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation: The CHAMPION AF Randomized Trial","volume":"394","author":"Griffin J.","year":"2026","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_4_4_1","first-page":"985","article-title":"Left Atrial Appendage Closure Versus Medical Therapy in Patients With Atrial Fibrillation and High Bleeding Risk: The CLOSURE AF Trial","volume":"394","author":"Bozig G.","year":"2026","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_4_5_1","first-page":"2011","article-title":"Left Atrial Appendage Closure Versus Oral Anticoagulation After Catheter Ablation for Atrial Fibrillation: The OPTION Randomized Trial","volume":"391","author":"Reddy V. Y.","year":"2024","journal-title":"New England Journal of Medicine"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70493","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.70493","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70493","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:39:03Z","timestamp":1789479543000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.70493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":4,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/jce.70493"],"URL":"https:\/\/doi.org\/10.1111\/jce.70493","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}