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Efficacy and safety of left atrial appendage closure procedure in patients with non-valvular atrial fibrillation with contraindication and/or failure for oral anticoagulants: A systematic review and meta-analysis.
Simões, Ricardo Dos Santos; Bortoluzzi, Aline Frossard Ribeiro; Marinho, Janaina Cardoso Nunes; Galendi, Julia Simões Corrêa; Bernardo, Wanderley Marques.
Afiliação
  • Simões RDS; Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil, Unimed do Brasil, São Paulo, SP, Brazil.
  • Bortoluzzi AFR; Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil, Unimed do Brasil, São Paulo, SP, Brazil.
  • Marinho JCN; Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil, Unimed do Brasil, São Paulo, SP, Brazil. Electronic address: janaina.marinho@unimed.coop.br.
  • Galendi JSC; Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil, Unimed do Brasil, São Paulo, SP, Brazil.
  • Bernardo WM; Núcleo de Avaliação de Tecnologias em Saúde da Unimed do Brasil, Unimed do Brasil, São Paulo, SP, Brazil.
Clinics (Sao Paulo) ; 79: 100465, 2024.
Article em En | MEDLINE | ID: mdl-39216123
ABSTRACT

BACKGROUND:

With the aim of reducing the risk of Cerebrovascular Accident (CVA) in patients with Non-Valvular Atrial Fibrillation (NVAF), Left Atrial Appendage Occlusion (LAAO) devices are emerging as an alternative to oral anticoagulants.

OBJECTIVE:

To analyze the efficacy and safety of the LAAO procedure in patients with NVAF and contraindications and/or failure for oral anticoagulants.

METHOD:

The search for evidence was carried out in the electronic databases Medline and Embase till January 2024. Additional searches were conducted on Google Scholar. The clinical trials registry database was also consulted. Two blinded investigators performed the search, study selection, and data collection, and assessed quality and risk of bias using the Cochrane tool for randomized clinical trials. Meta-analyses of eligible trials were performed using RevMan 5.4.1 software. The random effects model was used for all analyses.

RESULTS:

Five articles were selected, among which three were non-inferiority randomized clinical trials that analyzed the performance and safety of LAAO devices compared to the use of Vitamin K Antagonists (AVKs) or Novel Oral Anticoagulants (NOACs). No randomized clinical trials were found that analyzed populations with absolute contraindications to oral anticoagulants. Having as primary outcomes analyzed the occurrence of stroke (ischemic or hemorrhagic), cardiovascular or unexplained death and systemic embolism, the non-inferiority of the LAAO procedure compared to the use of oral anticoagulants was verified.

CONCLUSIONS:

For patients with an absolute contraindication to anticoagulation and/or failure to use oral anticoagulants, evidence for the use of LAAO devices is scarce.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Apêndice Atrial / Anticoagulantes Limite: Humans Idioma: En Revista: Clinics (Sao Paulo) Assunto da revista: MEDICINA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Apêndice Atrial / Anticoagulantes Limite: Humans Idioma: En Revista: Clinics (Sao Paulo) Assunto da revista: MEDICINA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos