{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:26:22Z","timestamp":1791779182689,"version":"4.3.4"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,8,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Percutaneous left atrial appendage closure (LAAC) has been suggested as an alternative to long\u2010term oral anticoagulation for nonvalvular atrial fibrillation, but comparative data remain scarce. We aimed to assess ischemic and bleeding outcomes of LAAC compared with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for the prevention of cardioembolic events in patients with atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Embase and MEDLINE were searched for randomized trials comparing LAAC, VKAs, and DOACs. The primary efficacy end point was any stroke or systemic embolism. Treatment effects were calculated from a network meta\u2010analysis and ranked according to the surface under the cumulative ranking curve. Seven trials and 73\u2009199 patients were included. The risk of the primary end point was not statistically different between LAAC versus VKAs (odds ratio [OR], 0.92 [95% CI, 0.62\u20131.50]) and LAAC versus DOACs (OR, 1.11 [95% CI, 0.71\u20131.73]). LAAC and DOACs resulted in similar risk of major or minor (OR, 0.93 [95% CI, 0.61\u20131.42]) and major bleeding (OR, 0.92 [95% CI, 0.58\u20131.46]); however, after exclusion of procedural bleeding, bleeding risk was significantly lower in those undergoing LAAC. Both LAAC and DOACs reduced the risk of all\u2010cause death\u00a0 compared with VKAs (LAAC versus VKAs: OR, 0.70 [95% CI, 0.53\u20130.91]; DOACs versus VKAs: OR, 0.90 [95% CI, 0.85\u20130.95], respectively). DOACs ranked as the best treatment for stroke or systemic embolism prevention (66.9%) and LAAC for reducing major bleeding (63.9%) and death (96.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">As a nonpharmacological alternative to oral anticoagulation for atrial fibrillation, LAAC showed similar efficacy and safety compared with VKAs or DOACs. Prospective confirmation from larger studies is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.034815","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T07:34:46Z","timestamp":1723188886000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Left Atrial Appendage Closure Compared With Oral Anticoagulants for Patients With Atrial Fibrillation: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0561-7563","authenticated-orcid":false,"given":"Angelo","family":"Oliva","sequence":"first","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"},{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele MI Italy"},{"name":"Cardio Center Humanitas Clinical and Research Hospital IRCCS Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6002-064X","authenticated-orcid":false,"given":"Anna Maria","family":"Ioppolo","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Chiarito","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele MI Italy"},{"name":"Cardio Center Humanitas Clinical and Research Hospital IRCCS Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cremonesi","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"},{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele MI Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Azzano","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7907-7128","authenticated-orcid":false,"given":"Eligio","family":"Miccich\u00e8","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8630-7817","authenticated-orcid":false,"given":"Andrea","family":"Mangiameli","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8734-6180","authenticated-orcid":false,"given":"Francesco","family":"Ariano","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-1464","authenticated-orcid":false,"given":"Giuseppe","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele MI Italy"},{"name":"Cardio Center Humanitas Clinical and Research Hospital IRCCS Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-5582","authenticated-orcid":false,"given":"Bernhard","family":"Reimers","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele MI Italy"},{"name":"Cardio Center Humanitas Clinical and Research Hospital IRCCS Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8960-7006","authenticated-orcid":false,"given":"Philippe","family":"Garot","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris Sud (ICPS), H\u00f4pital Priv\u00e9 Jacques Cartier Ramsay\u2010Sant\u00e9 Massy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9092-4458","authenticated-orcid":false,"given":"Nicolas","family":"Amabile","sequence":"additional","affiliation":[{"name":"Institut Cardiovasculaire Paris Sud (ICPS), H\u00f4pital Priv\u00e9 Jacques Cartier Ramsay\u2010Sant\u00e9 Massy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-262X","authenticated-orcid":false,"given":"Roxana","family":"Mehran","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. 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