Efficacy And Safety Of Left Atrial Appendage Closure And New Oral Anticoagulants In Stroke Prevention In Patients With Non-valvular Atrial Fibrillation:A Single Group Meta-analysis

Background:Atrial fibrillation is an arrhythmia that is very common in adults and increases the risk of stroke five times.At present,the measures to prevent stroke in patients with atrial fibrillation include oral anticoagulants(VKA and NOAC)and non-drug treatment.The use of VKA is limited by the interval of treatment.It is necessary to monitor the international normalized ratio(INR)and adjust the dosage of drugs.In addition,warfarin is also easily affected by drugs,diet and various disease factors,so the INR compliance rate of patients with AF who take warfarin orally is generally low.The efficacy of NOAC in the prevention of stroke is similar to warfarin.It is not necessary to monitor INR repeatedly in the process of use.However,the price of many new oral anticoagulants is higher than their own expectations,and it is difficult to popularize them in clinical practice in the short term.Therefore,the current focus is on the device therapy that does not increase the risk of bleeding.Percutaneous left atrial appendage occlusion(LAAC)has gradually become a new choice for non-valvular atrial fibrillation patients with higher stroke risk and anticoagulant contraindications.With the increasing number of LAAC at home and abroad,the effect and risk of LAAC need more research to further evaluate.Objective:To evaluate the efficacy and safety of percutaneous left atrial appendage occlusion or new oral anticoagulants in preventing ischemic stroke in patients with non-valvular atrial fibrillation.Method:PubMed,Embase,Cochrane Library,CNKI,CBM,Wanfangand VIP databases were searched in Chinese and English from the establishment of the database to January 2021.Literatures related to left atrial appendage occlusion or new oral anticoagulants in the prevention of stroke were searched.The included literatures should be consistent with the inclusion and exclusion criteria.Because of the lack of RCT at home and abroad,we need to retrieve the important outcome indicators of each study in Chinese and English databases.The main outcome indicator is ischemic stroke and massive hemorrhage,and the secondary outcome indicator is all-cause death.According to the inclusion and exclusion criteria,literatures were screened and meta-analysis of single group event rate was performed by stata15.1 software.fzfv Result:A total of 16 related studies were included in this study,and the total number of cases was 73240.The results of single group event rate analysis showed that the incidence of ischemic stroke in LAAC was lower than that in NOAC(0.02:0.03),the incidence of massive hemorrhage in LAAC was lower than that in NOAC(0.02:0.04),and the all-cause mortality in LAAC was lower than that in NOAC(0.03:0.07).Conclusion:The incidence of ischemic stroke,massive hemorrhage and all-cause mortality of LAAC were lower than those of NOAC,indicating that LAAC is no less effective and safe than NOAC in preventing stroke.In order to further verify the difference of efficacy and safety between percutaneous left atrial appendage occlusion and new oral anticoagulants,more RCTs are needed to confirm in the future.In particular,a randomized controlled study directly comparing LAAC with NOAC.