{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:33:37Z","timestamp":1790883217455,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004731","name":"Natural Science Foundation of Zhejiang Province","doi-asserted-by":"publisher","award":["LQ19H020007"],"award-info":[{"award-number":["LQ19H020007"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81900393"],"award-info":[{"award-number":["81900393"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Left atrial appendage (LAA) closure is an alternative to oral anticoagulants (OAC) for stroke prevention in atrial fibrillation (AF), but comparative evidence remains inconsistent. This study systematically evaluates the efficacy and safety of LAA closure versus OAC in AF patients. Methods: We systematically searched PubMed, EmBase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) and propensity score-matched (PSM) studies published up to 30 September 2025. Treatment effects were estimated using relative risks (RR) with 95% confidence intervals (CI), and a random-effects model was applied for all analyses. Results: Fifteen studies (17,116 AF patients) were included, comprising 4 RCTs, 3 prospective PSM studies, and 8 retrospective PSM studies. Compared with OAC, LAA closure significantly reduced the composite endpoint (RR: 0.79; 95% CI: 0.66\u20130.95; p = 0.010), all-cause mortality (RR: 0.58; 95% CI: 0.49\u20130.69; p &lt; 0.001), and cardiovascular mortality (RR: 0.55; 95% CI: 0.44\u20130.67; p &lt; 0.001). Risks of any stroke (RR: 1.06; 95% CI: 0.86\u20131.31; p = 0.555), ischemic stroke (RR: 1.00; 95% CI: 0.85\u20131.17; p = 0.972), hemorrhagic stroke (RR: 0.96; 95% CI: 0.54\u20131.70; p = 0.879), and major bleeding (RR: 0.84; 95% CI: 0.67\u20131.04; p = 0.112) were not significantly different between groups. Conclusions: In AF patients, LAA closure significantly reduces mortality and a composite clinical endpoint compared to OAC, with similar risks of stroke and major bleeding. It is a favorable alternative for patients unsuitable for long-term anticoagulation.<\/jats:p>","DOI":"10.3390\/jcdd12120483","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Left Atrial Appendage Closure Versus Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Chen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinliang","family":"Nan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8288-3501","authenticated-orcid":false,"given":"Danyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","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":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1093\/ehjqcco\/qcaa061","article-title":"Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990\u20132017: Results from the Global Burden of Disease Study 2017","volume":"7","author":"Dai","year":"2021","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_3","first-page":"103784","article-title":"SCAI\/HRS Technical Review on Transcatheter Left Atrial Appendage Occlusion","volume":"4","author":"Cronin","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chen, C., Chen, Y., Qu, L., Su, X., and Chen, Y. (2023). 3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: Cardiomyopathy related with increased death and stroke rate. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03054-9"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study","volume":"386","author":"Schnabel","year":"2015","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1038\/nrcardio.2014.118","article-title":"Global epidemiology of atrial fibrillation","volume":"11","author":"Rahman","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1136\/heartjnl-2018-314471","article-title":"Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013","volume":"105","author":"Gallagher","year":"2019","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Pyyk\u00f6nen, M., Linna, M., Tykkyl\u00e4inen, M., Delmelle, E., and Laatikainen, T. (2021). Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-07125-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.recesp.2018.05.024","article-title":"International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists","volume":"72","author":"Santas","year":"2019","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1055\/a-2161-0928","article-title":"Prevalence and Predictors of Nonadherence to Direct Oral Anticoagulant Treatment in Patients with Atrial Fibrillation","volume":"7","author":"Chu","year":"2023","journal-title":"TH Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.jacasi.2024.07.013","article-title":"1-Year Clinical Outcomes and the Impact of Procedural Configurations in Left Atrial Appendage Occlusion Patients","volume":"4","author":"Gao","year":"2024","journal-title":"JACC Asia"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Barletta, V., Alberti, M., Agostini, R., Pizzino, F., Trimarchi, G., D\u2019Alfonso, M.G., Solari, M., Zucchelli, G., and Cresti, A. (2025). Optimizing Imaging Techniques for Left Atrial Appendage Closure: Insights and Emerging Directions. J. Clin. Med., 14.","DOI":"10.3390\/jcm14103607"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_16","unstructured":"Wells, G., Shea, B., and O\u2019Connell, D. (2009). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, Ottawa Hospital Research Institute. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.htm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin. Trials"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1177\/0272989X05282643","article-title":"The interpretation of random-effects meta-analysis in decision models","volume":"25","author":"Ades","year":"2005","journal-title":"Med. Decis. Mak."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Higgins, J., and Green, S. (2008). Analyzing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions 5.0.1, The Cochrane Collaboration. Chapter 9.","DOI":"10.1002\/9780470712184"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_21","first-page":"15","article-title":"Assessing the influence of a single study in meta-analysis","volume":"47","author":"Tobias","year":"1999","journal-title":"Stata Tech. Bull."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1136\/bmj.326.7382.219","article-title":"Interaction revisited: The difference between two estimates","volume":"326","author":"Altman","year":"2003","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1002\/sim.1187","article-title":"How should meta-regression analyses be undertaken and interpreted?","volume":"21","author":"Thompson","year":"2002","journal-title":"Stat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2014.04.029","article-title":"Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial","volume":"64","author":"Holmes","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1001\/jama.2014.15192","article-title":"Percutaneous left atrial appendage closure vs. warfarin for atrial fibrillation: A randomized clinical trial","volume":"312","author":"Reddy","year":"2014","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3122","DOI":"10.1016\/j.jacc.2020.04.067","article-title":"Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients with Atrial Fibrillation","volume":"75","author":"Osmancik","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.4244\/EIJ-D-19-00507","article-title":"Percutaneous left atrial appendage closure versus non-vitamin K oral anticoagulants in patients with non-valvular atrial fibrillation and high bleeding risk","volume":"15","author":"Godino","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jcin.2020.09.051","article-title":"Clinical Outcomes Associated with Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation","volume":"14","author":"Korsholm","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.repc.2020.07.021","article-title":"Non-vitamin K antagonist oral anticoagulation versus left atrial appendage occlusion for primary and secondary stroke prevention after cardioembolic stroke","volume":"40","author":"Paiva","year":"2021","journal-title":"Rev. Port. Cardiol. (Engl. Ed.)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1007\/s00392-021-01983-z","article-title":"Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants in atrial fibrillation","volume":"111","author":"Ding","year":"2022","journal-title":"Clin. Res. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e027001","DOI":"10.1161\/JAHA.121.027001","article-title":"Percutaneous Left Atrial Appendage Occlusion in Comparison to Non-Vitamin K Antagonist Oral Anticoagulant Among Patients with Atrial Fibrillation","volume":"11","author":"Noseworthy","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_35","first-page":"304","article-title":"Left atrial appendage closure versus DOAC in elderly patients: A propensity score matching study","volume":"4","year":"2022","journal-title":"REC Interv. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijcard.2022.06.065","article-title":"Clinical outcomes of left atrial appendage occlusion versus direct oral anticoagulation in patients with atrial fibrillation and prior ischemic stroke: A propensity-score matched study","volume":"363","author":"Korsholm","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Tiosano, S., Banai, A., Mulla, W., Goldenberg, I., Bayshtok, G., Amit, U., Shlomo, N., Nof, E., Rosso, R., and Glikson, M. (2023). Left Atrial Appendage Occlusion versus Novel Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation-One-Year Survival. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206693"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e029421","DOI":"10.1161\/JAHA.123.029421","article-title":"Clinical Outcomes of Left Atrial Appendage Occlusion Versus Switch of Direct Oral Antcoagulant in Atrial Fibrillation: A Territory-Wide Retrospective Analysis","volume":"12","author":"Ng","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.amjcard.2023.07.059","article-title":"Efficacy of Left Atrial Appendage Closure and Oral Anticoagulation After Atrial Fibrillation Catheter Ablation","volume":"204","author":"Fei","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/j.hrthm.2024.05.038","article-title":"Percutaneous left atrial appendage closure for stroke prevention in hypertrophic cardiomyopathy patients with atrial fibrillation","volume":"21","author":"Aglan","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_41","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."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jacc.2017.10.092","article-title":"Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study","volume":"71","author":"Lakkireddy","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1136\/svn-2024-003142","article-title":"Left atrial appendage closure for patients with atrial fibrillation at high intracranial haemorrhagic risk","volume":"10","author":"Yaghi","year":"2025","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.amjcard.2023.05.044","article-title":"An Updated Meta-Analysis on the Clinical Outcomes of Percutaneous Left Atrial Appendage Closure Versus Direct Oral Anticoagulation in Patients with Atrial Fibrillation","volume":"200","author":"Jiang","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s12471-019-1295-5","article-title":"Left atrial appendage closure in atrial fibrillation patients with prior major bleeding or ineligible for oral anticoagulation","volume":"27","author":"Wintgens","year":"2019","journal-title":"Neth. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"La Fazia, V.M., Galea, R., Della Rocca, D.G., Gianni, C., Gasys, A., Mohanty, S., Madhkour, R., Pierucci, N., Torlapati, P.G., and Chalkou, K. (2025). Impact of Device Compression on Peridevice Leak After Left Atrial Appendage Closure: The Impression LAAC Study. JACC Clin. Electrophysiol.","DOI":"10.1016\/j.jacep.2025.08.014"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/12\/483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:26:49Z","timestamp":1765344409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/12\/483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcdd12120483"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12120483","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}