{"id":"c743f13ca754","type":"article","url":"https://hartvaat.nl/2026/11/01/linkeratriumappendix-sluiting-vermindert-niet-procedurele-bloedingen-zonder-slag/","title":"Linkeratriumappendix-sluiting vermindert niet-procedurele bloedingen zonder slagoffer-bescherming boven anticoagulantia","title_en":"Updated Meta-Analysis of Left Atrial Appendage Closure Versus Oral Anticoagulation to Prevent Stroke in Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Stroke","doi":"10.1161/STROKEAHA.126.057089","source_url":"https://doi.org/10.1161/STROKEAHA.126.057089","authors":["Prince K Pekyi-Boateng","Arankesh Mahadevan","Smith Kofi Frimpong","Lilly Kanishka","Stephen Gbekor","Hamilton Abimbilla","Brian Jose Villafuerte Trisolini","George Akyea Blankson","Patrick Deladem Pekyi-Boateng","Dan Youg Nguyen","Omid Shoraka","Jana Wold","Aaron Shoskes","Stephanie Lyden","Pugazhendhi Vijayaraman","Jaydevsinh Dolia","Jennifer J Majersik","Anwar Tandar","Karol P Budohoski","Ramesh Grandhi"],"significance":7,"published":"2026-11-04","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"An updated meta-analysis of six randomized trials (7,028 patients) comparing percutaneous left atrial appendage closure (LAAC) with oral anticoagulation in nonvalvular atrial fibrillation found similar overall stroke rates between the two strategies, but a significant reduction in nonprocedural bleeding with LAAC (OR 0.58). Ischemic stroke rates were numerically higher with LAAC (OR 1.41), though not reaching the required information size. These findings position LAAC primarily as a bleeding-reduction strategy for anticoagulation-eligible patients at standard-to-moderate bleeding risk, rather than a direct substitute for oral anticoagulants in stroke prevention.","created":"2026-10-28T02:35:16Z","updated":"2026-10-28T02:35:16Z","licence":"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.","body_markdown":"Een update van de meta-analyse van zes RCT’s (7028 patiënten) toont aan dat percutane sluiting van de linkeratriumappendix (LAAC) bij niet-valvulair atriumfibrilleren vergelijkbare slagofferraten geeft als orale anticoagulantia, maar het risico op niet-procedurele bloedingen significant verlaagt (OR 0,58). Het aantal ischemische slagoffers was zelfs iets hoger bij LAAC (OR 1,41), zij het zonder statistische significantie voor voldoende informatiegrootte. Voor de klinische praktijk betekent dit dat LAAC vooral een waardevol alternatief is voor patiënten met een standaard tot matig bloedingrisico, en niet als directe vervanger van anticoagulantia voor slagofferpreventie.","abstract_original":"BACKGROUND: Ninety percent of left atrial thrombi in nonvalvular atrial fibrillation arise in the left atrial appendage, which can be occluded percutaneously (left atrial appendage closure [LAAC]). Two 2026 trials (CHAMPION-AF [Watchman Flx Versus Non-Vitamin K Antagonist Oral Anticoagulant for Embolic Protection in the Management of Patients With Non-Valvular Atrial Fibrillation] and CLOSURE-AF [Left Atrial Appendage Closure in Patients With Atrial Fibrillation Compared to Medical Therapy]) more than doubled the available randomized evidence comparing LAAC with oral anticoagulation. We evaluated pooled effects of LAAC on stroke, bleeding, and mortality by bleeding risk, anticoagulation eligibility, and comparator. METHODS: In this systematic review and meta-analysis, we searched PubMed, Scopus, and Embase from inception to April 15, 2026, for randomized controlled trials comparing percutaneous LAAC with oral anticoagulation in nonvalvular atrial fibrillation. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool. Cumulative-incidence outcomes were pooled as odds ratios using random-effects models, with prediction intervals, prespecified subgroups, and trial sequential analysis. RESULTS: Six randomized controlled trials (2014-2026; 358 sites in North America, Europe, and Asia; 7028 patients) compared LAAC with warfarin (2 trials) or a direct oral anticoagulant (4 trials); populations were predominantly anticoagulation-eligible with low prior-stroke prevalence, plus 2 high-bleeding-risk and 1 postablation trial. Overall stroke rates were similar between arms (odds ratio, 1.10 [95% CI, 0.78-1.56]). Ischemic stroke was more frequent with LAAC (odds ratio, 1.41 [95% CI, 1.07-1.86]) but did not reach the required information size. Nonprocedural bleeding was lower with LAAC (odds ratio, 0.58 [95% CI, 0.35-0.96]), the only outcome reaching a sufficient information size, in standard-risk and postablation but not high-bleeding-risk patients. CONCLUSIONS: LAAC is best positioned to reduce nonprocedural bleeding in anticoagulation-eligible patients at standard-to-moderate bleeding risk, rather than as a stroke-equivalent substitute for oral anticoagulation. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420261370546."}