LAAC or DOACs? How treatment strategies for AFib impact long-term outcomes

Left atrial appendage closure (LAAC) is noninferior to direct oral anticoagulants (DOACs) when it comes to the long-term prevention of major cardiovascular, neurological or bleeding events among patients with atrial fibrillation (AFib), according to new research published in the Journal of the American College of Cardiology. In fact, LAAC also associated with a key benefit over DOAC therapy. 

"LAAC is a nonpharmacologic option for preventing cardioembolic events in patients with AFib at significant stroke risk," wrote lead author Pavel Osmancik, MD, PhD, a specialist at University Hospital Kralovske Vinohrady in Prague, and colleagues. "However, long-term results from randomized clinical trials are sparse."

The group set out to evaluate data from the PRAGUE-17 trial, focusing on 402 AFib patients treated between October 2015 and January 2019.

Sixty-six percent of patients were men, and the median patient age was 73.3 years old.

In the analysis, 201 LAAC patients and another 201 DOAC patients were followed for a median of 3.5 years.

Overall, the group found, LAAC was noninferior to DOACs when it came to preventing stroke, transient ischemic attack, systemic embolism, significant bleeding events, device-related complications and cardiovascular death. In fact, LAAC was linked to a lower rate of nonprocedural bleeding events. 

“In our study, the benefit of LAAC on clinically relevant bleeding was derived from a reduction in late events," the authors wrote. “Events during the first-year postimplantation are primarily driven by procedural complications and postimplantation antithrombotic medications, so the benefit of LAAC was best appreciated over longer periods of follow-up. These findings are in agreement with other randomized trials of LAAC in patients with AFib.”

Read the full study here.

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