{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:49:57Z","timestamp":1791622197847,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"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":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Left atrial appendage occlusion (LAAO) has emerged as a non\u2010pharmacological alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). Following the publication of recent CHAMPION\u2010AF and CLOSURE\u2010AF trials, an updated synthesis of evidence is warranted to clarify the long\u2010term comparative efficacy and safety of LAAO versus OAC in patients with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta\u2010analysis of randomized controlled trials (RCTs) comparing LAAO with OAC in adults with AF. A comprehensive search of major databases was performed from inception to April 2026. The primary efficacy outcomes were major adverse cardiovascular events (MACE) and stroke. The primary safety outcome was non\u2013procedure\u2010related bleeding. Random\u2010effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs including 7,004 patients (3,681 LAAO; 3,323 OAC) were analyzed. No statistically significant difference was observed for MACE (7.5% vs 6.9%; RR 1.03, 95% CI 0.79\u20101.34) or stroke (3.7% vs 3.2%; RR 1.07, 95% CI 0.80\u20101.43). LAAO was associated with a significantly lower risk of non\u2010procedure\u2010related bleeding (9.8% vs 16.7%; RR 0.63, 95% CI 0.52\u20100.77), corresponding to an absolute risk reduction of 6.9% and an approximate number needed to treat of 15 based on crude pooled event rates over the observed trial follow\u2010up. Trial sequential analysis indicated that the accumulated evidence for MACE and stroke remained inconclusive. Comparator\u2010type subgroup analyses showed no significant interaction for MACE (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.67) or stroke (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.81) between contemporary predominantly\u2010DOAC and VKA comparator trials.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LAAO was associated with lower non\u2010procedure\u2010related bleeding, while no statistically significant differences were observed for MACE or stroke. The available efficacy evidence remains inconclusive regarding equivalence or non\u2010inferiority, and larger trials are needed. These findings support individualized consideration of LAAO when the long\u2010term bleeding burden of anticoagulation is clinically important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70465","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:54:45Z","timestamp":1791615285000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Appendage Occlusion vs Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation: A Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9474-324X","authenticated-orcid":false,"given":"Ahmed","family":"Nazmy","sequence":"first","affiliation":[{"name":"Faculty of Medicine Kafr\u2010Elsheikh University  Kafr\u2010Elsheikh Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5449-8833","authenticated-orcid":false,"given":"Alaa Abdrabou","family":"Abouelmagd","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Qena University  Qena Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3173-4991","authenticated-orcid":false,"given":"Ahmed","family":"Sobhy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kafr\u2010Elsheikh University  Kafr\u2010Elsheikh Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4199-4242","authenticated-orcid":false,"given":"Mennatullah","family":"Ashour","sequence":"additional","affiliation":[{"name":"College of Human Medicine Banha University  Banha Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-4833","authenticated-orcid":false,"given":"Hassan","family":"El\u2010shirbiny","sequence":"additional","affiliation":[{"name":"Cardiology Department, Faculty of Medicine Kafr Elsheikh University  Kafr El Sheikh Egypt"},{"name":"Department of Electrophysiology, Heart and Diabetes Center NRW Ruhr University Bochum  Bad Oeynhausen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2454-1335","authenticated-orcid":false,"given":"Moneeb","family":"Khalaph","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart and Diabetes Center NRW Ruhr University Bochum  Bad Oeynhausen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Yasser","family":"Shaban","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2990-0518","authenticated-orcid":false,"given":"Mahmoud","family":"Nazmy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kafr\u2010Elsheikh University  Kafr\u2010Elsheikh Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4180-5065","authenticated-orcid":false,"given":"Amroos","family":"Shabaan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Qena University  Qena Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Farahat","family":"Elbanna","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-3885","authenticated-orcid":false,"given":"Abdelrahman","family":"Hafez","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Arizona College of Medicine Phoenix  Phoenix Arizona USA"},{"name":"Department of Cardiovascular Medicine Mayo Clinic  Phoenix and Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4857-9125","authenticated-orcid":false,"given":"C. Michael","family":"Gibson","sequence":"additional","affiliation":[{"name":"Baim Institute for Clinical Research, Harvard Medical School Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.07.014"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010022\u201014403\u20102"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.102181"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010146\u201012\u2010200706190\u201000007"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.1.41"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000208294.46968.a4"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.31083\/RCM39233"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae398"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003\u20104975(95)00887\u2010X"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15192"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2517213"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2513310"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_18_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. P. T.","year":"2024"},{"key":"e_1_2_12_19_1","unstructured":"Clarivate\u201cEndNote [computer software] \u201d Philadelphia PA: (Clarivate n.d.)."},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.17085\/apm.21038"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010017\u20100315\u20107"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphys.2024.05.008"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408308"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.034815"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.07.051"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2024.102880"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(13)62343\u20100"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101897"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70465","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70465","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:35:56Z","timestamp":1791621356000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":30,"alternative-id":["10.1111\/pace.70465"],"URL":"https:\/\/doi.org\/10.1111\/pace.70465","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"2026-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70465"}}