Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment—a systematic review and meta-analysis

Labori, Frida; Bonander, Carl; Persson, Josefine; Svensson, Mikael

doi:10.1007/s10840-021-00953-9

Cited by 14 publications

(8 citation statements)

References 43 publications

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“…Observational data from registries and follow-up studies for LAAC [ 42 , 43 ] and novel oral anticoagulants [ 44 , 45 ] possess the potential to exert a transformative influence on the determination of treatment efficacy, thereby potentially reshaping the cost-effectiveness assessment of LAAC in the domain of stroke prevention. For example, the meta-analysis [ 46 ] used by Labori and colleagues [ 28 ] to retrieve treatment effects for LAAC examined 29 studies, including trials, observational studies and registries. It is noteworthy that other studies which utilised only trial data did not present a rationale for the omission of observational studies from the process of data synthesis despite best practice guidelines suggesting otherwise [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality

Hewage,

Noviyani,

Brain

et al. 2023

Cost Eff Resour Alloc

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Background The increasing global prevalence of atrial fibrillation (AF) has led to a growing demand for stroke prevention strategies, resulting in higher healthcare costs. High-quality economic evaluations of stroke prevention strategies can play a crucial role in maximising efficient allocation of resources. In this systematic review, we assessed the methodological quality of such economic evaluations. Methods We searched electronic databases of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Econ Lit to identify model-based economic evaluations comparing the left atrial appendage closure procedure (LAAC) and oral anticoagulants published in English since 2000. Data on study characteristics, model-based details, and analyses were collected. The methodological quality was evaluated using the modified Economic Evaluations Bias (ECOBIAS) checklist. For each of the 22 biases listed in this checklist, studies were categorised into one of four groups: low risk, partial risk, high risk due to inadequate reporting, or high risk. To gauge the overall quality of each study, we computed a composite score by assigning + 2, 0, − 1 and − 2 to each risk category, respectively. Results In our analysis of 12 studies, majority adopted a healthcare provider or payer perspective and employed Markov Models with the number of health states varying from 6 to 16. Cost-effectiveness results varied across studies. LAAC displayed a probability exceeding 50% of being the cost-effective option in six out of nine evaluations compared to warfarin, six out of eight evaluations when compared to dabigatran, in three out of five evaluations against apixaban, and in two out of three studies compared to rivaroxaban. The methodological quality scores for individual studies ranged from 10 to − 12 out of a possible 24. Most high-risk ratings were due to inadequate reporting, which was prevalent across various biases, including those related to data identification, baseline data, treatment effects, and data incorporation. Cost measurement omission bias and inefficient comparator bias were also common. Conclusions While most studies concluded LAAC to be the cost-effective strategy for stroke prevention in AF, shortcomings in methodological quality raise concerns about reliability and validity of results. Future evaluations, free of these shortcomings, can yield stronger policy evidence.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality

Hewage,

Noviyani,

Brain

et al. 2023

Cost Eff Resour Alloc

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“…Patients undergoing the LAAC procedure after the release of 2020 ESC guidelines for the diagnosis and management of atrial fibrillation were qualified in accordance with them-LAA occlusion may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment (e.g., intracranial bleeding without a reversible cause) (Class IIB, level B). Previously, 2016 ESC guidelines for AF management were used (Class IIB, level B) [18]. Abbreviations: HCT-hematocrit; HGB-hemoglobin; LVEF-left ventricular ejection fraction; PLTs-platelets; RBCs-red blood cells.…”

Section: Indications For Left Atrial Appendage Closure (Laac)mentioning

confidence: 99%

Anticoagulants versus Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation and Co-Morbid Thrombocytopenia

Kowalska,

Mitręga,

Olma

et al. 2023

JCM

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Left atrial appendage closure (LAAC) is an alternative approach to anticoagulants. Nonetheless, data regarding the outcomes of LAAC procedures in patients with thrombocytopenia remain lacking. The primary objective was to determine the incidence of the composite endpoint comprising ischemic stroke, intracranial hemorrhage, major bleeding, and cardiac cause of death among patients with atrial fibrillation (AF) and thrombocytopenia who were either undergoing LAAC or receiving oral anticoagulants. The secondary endpoint was the determination of total mortality. Data from a prospective, single-center registry of patients undergoing LAAC procedures were analyzed. A subset of 50 consecutive patients with thrombocytopenia were selected. Thrombocytopenia was defined as a thrombocyte count below 150,000. Subsequently, from patients hospitalized with AF receiving oral anticoagulants, 50 patients were further chosen based on propensity score matching, ensuring comparability with the study group. The primary endpoint occurred in 2% of patients in the LAAC group and 10% of patients in the non-LAAC group (p = 0.097). Additionally, a significant difference was noted in the occurrence of the secondary endpoint, which was observed in 0% of patients in the LAAC group and 10% of patients in the non-LAAC group (p = 0.025). In patients with thrombocytopenia the LAAC procedure improves prognosis compared with continued anticoagulant treatment.

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“…While this was not the first meta-analysis related to ICE guidance for LAAO procedures, 10,11 this meta-analysis provides information on lab efficiency, peridevice leaks, and residual interatrial septal defects.…”

mentioning

confidence: 99%

“…While this was not the first meta‐analysis related to ICE guidance for LAAO procedures, 10,11 this meta‐analysis provides information on lab efficiency, peridevice leaks, and residual interatrial septal defects. The reassuring findings of this meta‐analysis may help inform decision making for an operator considering making the switch from TEE guidance to ICE guidance.…”

mentioning

confidence: 99%

TEE versus ICE for LAAO: Is ICE just as nice?

Razminia,

D'Silva

2023

Cardiovasc electrophysiol

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Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment—a systematic review and meta-analysis

Cited by 14 publications

References 43 publications

Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality

Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality

Anticoagulants versus Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation and Co-Morbid Thrombocytopenia

TEE versus ICE for LAAO: Is ICE just as nice?

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