# Linker-hartoorsluiting: uitkomsten en kosten van trial en real-world versus orale antistolling

*geplaatst 2016-12-07 · Atriumfibrilleren · European heart journal · doi 10.1093/eurheartj/ehw048 · https://hartvaat.nl/2016/12/07/linker-hartoorsluiting-uitkomsten-en-kosten-van-trial-en-real-world-versus-orale/*

Vergelijkende analyse van uitkomsten en kosten van percutane linker-hartoorsluiting versus orale anticoagulantia bij AF, zowel uit gerandomiseerde trials als real-world data.

## English: Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation.

This analysis compared outcomes and costs of percutaneous left atrial appendage closure versus oral anticoagulation in AF patients from both randomized trial and real-world data, informing the value proposition of structural stroke prevention.

## Abstract (original, from the publication)

AIMS: The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. METHODS AND RESULTS: Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). CONCLUSION: Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation.

Auteurs: Sandeep Panikker, Joanne Lord, Julian W E Jarman, Shannon Armstrong, David G Jones, Shouvik Haldar, Charles Butcher, Habib Khan, Lilian Mantziari, Edward Nicol, Wajid Hussain, Jonathan R Clague, John P Foran, Vias Markides, Tom Wong

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehw048. Bijgewerkt 2026-07-03T13:25:46Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.