SAFETY OF LAA CLOSURE BY MINIMALLY INVASIVE PROCEDURE VS OACS IN PATIENTS WITH ATRIAL FIBRILLATION – AN UMBRELLA META-ANALYSIS
Tarun Parvataneni, MD1, Sudha Dirisanala, MD2, Keerthi Sripathi, MD3, Sireesha Matta Vemuri Reddy, MD4, Sharanya Rajgopal, MBBS5, Rutvij Patel, MD6, Mahmoud Aboukhreis, MD7, Venkata Harshabhargav, MD8, Parth Shah, MD9, Arjun Gandhi, MBBS10, Urvish Patel, MD, MPH11, Bhavya Yarlagadda, MD12, 1Department of Family Medicine, Aiken Regional Medical Center, SC, USA, ; 2Department of Internal Medicine,North East Georgia Medical Center,Gainesville,GA., ; 3Arkansas College of Osteopathic Medicine/Mercy Hospital,Fort Smith,Arkansas,USA, ; 4Aiken Regional Medical, SC, Aiken; 5Avalon University School of Medicine,Willemstad,Curacao., ; 6Department of Internal Medicine, Creighton University, Omaha, Nebraska, USA, ; 7Yeditepe University,faculty of Medicine,Istanbul,Turkey., ; 8University of Perpetual Help System Delta,Las Pinas,Philippines., ; 9Department of Internal Medicine,Reading Hospital,Tower Health,West Reading ,PA,USA, ; 10UCD School of Medicine, University College Dublin, Ireland, ; 11Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA, TX; 12Department of Internal Medicine,MUSC,Camden,South Carolina,USA,
Abstract Number: 0174
Background: This umbrella meta-analysis assesses the safety of left atrial appendage (LAA) closure by minimal invasive procedures compared to oral anticoagulants (OACs) in patients with atrial fibrillation (AF), concentrating on adverse events and overall clinical outcomes. The results seek to elucidate the most effective treatment. This umbrella meta-analysis intends to evaluate the safety and efficacy of minimally invasive LAA closure in comparison to OAC in AF.
Methods: We adhered to the PRISMA protocol to perform an umbrella meta-analysis of published meta-analyses comparing the outcomes of LAA occlusion using the Watchman or Amulet devices vs OACs in patients with atrial fibrillation (AF). Relevant studies were identified through PubMed using MeSH terms. Non-human studies, non-English publications, studies that were not meta-analyses, and those lacking outcome data were excluded based on predefined inclusion and exclusion criteria. Data analysis was conducted using RevMan 5.4, employing the inverse variance method and a random-effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Forest plots and heterogeneity (I²) were also generated, with statistical significance defined at an alpha level of 0.05. Risk of bias assessed by Newcastle-Ottawa Scale (NOS).
Results: Of 19 studies, 12 had data on outcomes. Watchman or Amulet devices had reduced odds of mortality [aOR: 0.65, 95%CI: 0.59-0.71, I²: 0%, p< 0.00001] [all cause mortality (0.70, 0.62-0.79, 0%, p< 0.00001), CV mortality (0.58, 0.50-0.67, 0%, p< 0.00001)], risk of stroke [0.77, 0.60-0.98, 75%, p=0.06], and major bleeding [0.76, 0.59-0.96, 61%, p=0.02] in comparison with OACs. NOS suggested a moderate risk of bias.
Conclusions: Watchman and Amulet devices provide safer left atrial appendage (LAA) closure than oral anticoagulants (OACs) in atrial fibrillation patients. All-cause, cardiovascular, stroke, and severe bleeding death rates are much lower. More prospective studies and clinical trials will help with risk stratification and cohort selection who may get the most benefit out of these procedures.
IMAGE 1: Odds of mortality, bleeding, and stroke following Minimal invasive procedures vs OACs in patients with atrial fibrillation
To cite this abstract:
Tarun Parvataneni, MD1, Sudha Dirisanala, MD2, Keerthi Sripathi, MD3, Sireesha Matta Vemuri Reddy, MD4, Sharanya Rajgopal, MBBS5, Rutvij Patel, MD6, Mahmoud Aboukhreis, MD7, Venkata Harshabhargav, MD8, Parth Shah, MD9, Arjun Gandhi, MBBS10, Urvish Patel, MD, MPH11, Bhavya Yarlagadda, MD12.
SAFETY OF LAA CLOSURE BY MINIMALLY INVASIVE PROCEDURE VS OACS IN PATIENTS WITH ATRIAL FIBRILLATION – AN UMBRELLA META-ANALYSIS.
Abstract published at SHM Converge 2025.
Abstract 0174
Journal of Hospital Medicine.
https://shmabstracts.org/abstract/safety-of-laa-closure-by-minimally-invasive-procedure-vs-oacs-in-patients-with-atrial-fibrillation-an-umbrella-meta-analysis/.
June 13th 2026.
