Atrial appendage occlusion in the prevention of ischemic stroke: a systematic review and meta-analysis

Paul E. Hernández-Montes, Departamento de Medicina General, Centro de Salud Juan Escutia; Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Tepic, Nayarit, México
Eliseo Añorve-García, Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Departamento de Cardiología Clínica, ISSSTE; Tepic, Nayarit, México
César J. Guitrón-Ramírez, Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Departamento de Medicina, Hospital General de Subzona, Clínica 08, IMSS; Tepic, Nayarit, México

The objective of this study was to evaluate the efficacy of percutaneous left atrial appendage occlusion (LAAO) compared with anticoagulation in patients with atrial fibrillation (AF) and its impact on the primary prevention of ischemic stroke and all-cause mortality. Patients with non-valvular AF and high thromboembolic risk (CHAâ??DSâ??-VASc > 2 points) were included. LAAO was compared against the use of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Articles were searched in PubMed, Scopus, and Web of Science up to June 11, 2025. Risk of bias was assessed using the RoB 2 tool and ROBINS-E, while statistical analysis was performed with Review Manager 5.4.1. A total of 10 studies with 5,779 patients were analyzed (2,916 with LAAO and 2,863 with anticoagulation). LAAO reduced, though without statistical significance, the incidence of ischemic stroke (OR: 0.82; 95% CI: 0.66–1.03; p = 0.09). However, it showed a significant reduction in all-cause mortality compared with the overall anticoagulant group (OR: 0.62; 95% CI: 0.46–0.80; p = 0.0004). LAAO emerges as a viable strategy to reduce mortality in patients with AF and high thromboembolic risk, particularly when long-term anticoagulation is not feasible. Its superiority over DOACs and comparable profile to VKAs, along with the absence of periodic INR monitoring and relevant drug interactions, make it an option that may optimize adherence and quality of life.

Keywords: Atrial fibrillation. Left atrial appendage occlusion. Anticoagulation. Isquemic stroke. Systematic review.