Is percutaneous closure of the left atrial appendage comparable to anticoagulants for atrial fibrillation?
For most atrial fibrillation patients oral anticoagulation constitutes the standard treatment to prevent stroke. However, they carry a risk of bleeding, which is why alternative treatments have been put into practice, such as percutaneous closure of the left atrial appendage. It is not clear whether this is as effective as the conventional treatment with anticoagulants. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including only one pertinent randomized controlled trial. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded that percutaneous left atrial appendage occlusion may decrease stroke and mortality, but the certainty of the evidence is low. The effect on other outcomes is not clear because the certainty of the evidence is very low.
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile. Email: jaimeanabalon@gmail.com.
Thomas
T
Uslar
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Pacientes Críticos, Hospital de Urgencia Asistencia Pública Dr. Alejandro del Río, Santiago, Chile; Proyecto Epistemonikos.
Jaime
J
Anabalón
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants