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

Treatment with this device can reduce risk of stroke, major bleeding, and death vs. other therapeutic strategies, which may offset additional upfront costs of device. Benefits are most apparent in those with higher baseline thromboembolic risk or unsuitable for anticoagulation.

Percutaneous occlusion of the left atrial appendage is a novel alternative strategy for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for long-term oral anticoagulation therapy. Several devices have been developed specifically for this purpose.

 

The researchers note this is the first cost-impact analysis using RCT and real-world patient data to compare left atrial appendage closure against currently available treatment options for the prevention of AF-related stroke and other clinical sequelae.

 

NICE issued interventional procedure on percutaneous occlusion of the left atrial appendage (LAA) in 2010, which noted that evidence suggests it is efficacious in reducing the risk of thromboembolic complications associated with non-valvular AF. With regard to safety, there is a risk of life-threatening complications from the procedure, but the incidence of these is low. Therefore, it was concluded this procedure may be used provided that normal arrangements are in place for clinical governance, consent and audit.