Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta-Analysis of Randomized Controlled Trials

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F25%3A43929088" target="_blank" >RIV/00064173:_____/25:43929088 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11120/25:43929088

Výsledek na webu

<a href="https://doi.org/10.1002/clc.70217" target="_blank" >https://doi.org/10.1002/clc.70217</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1002/clc.70217" target="_blank" >10.1002/clc.70217</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta-Analysis of Randomized Controlled Trials

Popis výsledku v původním jazyce

INTRODUCTION: Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear. METHODS: We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion. RESULTS: There were 476 articles identified from the search and 6 eligible RCTs were included (n = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64-3.46, I(2) = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59-1.70, I(2) = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18-2.97, I(2) = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, I(2) = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53-207.98, I(2) = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73-94.85, I(2) = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45-3.09). CONCLUSION: In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.

Název v anglickém jazyce

Comparing Effectiveness and Safety of Left Atrial Appendage Closure Devices: A Network Meta-Analysis of Randomized Controlled Trials

Popis výsledku anglicky

INTRODUCTION: Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear. METHODS: We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion. RESULTS: There were 476 articles identified from the search and 6 eligible RCTs were included (n = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64-3.46, I(2) = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59-1.70, I(2) = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18-2.97, I(2) = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, I(2) = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53-207.98, I(2) = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73-94.85, I(2) = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45-3.09). CONCLUSION: In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Clinical Cardiology

ISSN

0160-9289

e-ISSN

1932-8737

Svazek periodika

48

Číslo periodika v rámci svazku

11

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

8

Strana od-do

"e70217"

Kód UT WoS článku

001620104800001

EID výsledku v databázi Scopus

2-s2.0-105022638540