{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:46:33Z","timestamp":1791740793582,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Left atrial appendage closure (LAAC) is an emerging alternative for stroke prevention in patients with atrial fibrillation (AF) who are unsuitable for long\u2010term oral anticoagulants (OACs). However, its efficacy and safety relative to OACs remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three databases were searched up to April 7, 2026, for randomized controlled trials comparing LAAC with OAC in patients with AF. Risk ratios with 95% confidence intervals were pooled using a random\u2010effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097004 patients) were analyzed. The risk of stroke or systemic embolism (SSE) did not differ significantly between the LAAC and OAC groups (RR: 1.10 [0.87\u20131.39];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42). The risk of ischemic SSE was significantly increased with LAAC (RR: 1.41 [1.07\u20131.85];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) compared with OAC. No significant differences were observed in all\u2010cause mortality (RR: 0.94 [0.81\u20131.09]), cardiovascular mortality (RR: 0.91 [0.69\u20131.21]), non\u2010cardiovascular mortality (RR: 0.91 [0.75\u20131.12]), or hemorrhagic stroke (RR: 0.58 [0.29\u20131.17]). LAAC was associated with a similar risk of overall major bleeding (RR: 0.92 [0.77\u20131.09]) and low risk of non\u2010procedural bleeding (RR: 0.61 [0.52\u20130.73];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared with OAC. Upon sensitivity analysis comparing LAAC with DOACs, the findings remained consistent across most clinical outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAAC demonstrates comparable risks of SSE and major bleeding to OACs, but is associated with a higher risk of ischemic SSE\u00a0and reduced non\u2010procedural bleeding, supporting its use in selected patients at high risk for long\u2010term bleeding while emphasizing individualized shared decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70523","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:07:46Z","timestamp":1791738466000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Appendage Closure Versus Oral Anticoagulation for Prevention of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: An Updated Meta\u2010Analysis of 7004 Patients Across Six Randomized Trials"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0364-6475","authenticated-orcid":false,"given":"Aymen","family":"Ahmed","sequence":"first","affiliation":[{"name":"Section of Interventional Cardiology, Endeavor Center for Cardiovascular Intervention Outcomes Research and Evaluation (ECCORE), Endeavor Health Cardiovascular Institute The University of Chicago Pritzker School of Medicine Glenview Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8873-8557","authenticated-orcid":false,"given":"Neha Saleem","family":"Paryani","sequence":"additional","affiliation":[{"name":"Department of Medicine HCA Healthcare Houston Clear Lake\/University of Houston Webster Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muteia","family":"Shakoor","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, Endeavor Center for Cardiovascular Intervention Outcomes Research and Evaluation (ECCORE), Endeavor Health Cardiovascular Institute The University of Chicago Pritzker School of Medicine Glenview Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Golwala","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Knight Cardiovascular Institute Oregon Health &amp; Science University Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6383-4294","authenticated-orcid":false,"given":"Jonathan R.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Endeavor Health Cardiovascular Institute The University of Chicago Pritzker School of Medicine Glenview Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4053-597X","authenticated-orcid":false,"given":"Mark D.","family":"Metzl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Endeavor Health Cardiovascular Institute The University of Chicago Pritzker School of Medicine Glenview Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, Endeavor Center for Cardiovascular Intervention Outcomes Research and Evaluation (ECCORE), Endeavor Health Cardiovascular Institute The University of Chicago Pritzker School of Medicine Glenview Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. 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