Jens Erik Nielsen-Kudsk (Aarhus, Denmark) speaks to Cardiovascular News about a propensity score-matched study which examined left atrial appendage occlusion (LAAO) compared with novel oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with a high risk of stroke and major bleeding.
Nielsen-Kudsk outlines the main challenges of using NOACs in patients with AF, noting that while NOACs have “more or less replaced warfarin” due to a lower risk of adverse events, these drugs “still come with a bleeding problem”.
The findings of the study showed an improved composite clinical outcome for ischaemic stroke, major bleeding and mortality with LAAO compared to NOACs. A low and similar rate of ischaemic stroke was seen with LAAO and NOACs, whereas LAAO showed strikingly lower rates of major bleeding and mortality than NOACs.
Nielsen-Kudsk notes however that, being a propensity score-matched study, the level of evidence is “not the same” as in a randomised clinical trial. Fortunately, there are now several randomised clinical trials designed or commenced comparing the two treatments, he notes, before concluding that “I really hope in the next couple of years we can increase the evidence of this therapy even further”.