Left Atrial Appendage Closure vs. Oral Anticoagulation in Patients With Atrial Fibrillation: An Updated Systematic Review and Meta‐Analysis of Randomized Controlled Trials

ABSTRACT Background While oral anticoagulants (OACs) remain the cornerstone of stroke prevention, left atrial appendage closure (LAAC) is a potential alternative, particularly for patients with high bleeding risk or contraindications to long‐term anticoagulation. Methods Multiple databases were searched to identify relevant randomized controlled trials (RCTs), and four trials were shortlisted. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Outcomes assessed included stroke (all, ischemic, hemorrhagic), systemic embolism, major bleeding, non‐procedure‐related bleeding, and mortality. Risk of bias was evaluated using Rob 2.0, and meta‐analyses were conducted using RevMan software. Dichotomous outcomes were reported as risk ratios (RR) while continuous outcomes were reported as mean differences (MD), with 95% confidence intervals (CIs). Results A total of 3116 participants were analyzed across outcomes. LAAC significantly reduced non‐procedure‐related bleeding (RR: 0.48, 95% CI: 0.37–0.61; p < 0.00001) and all‐cause mortality (RR: 0.74, 95% CI: 0.55–0.99; p = 0.04). A marginal reduction was observed in the composite outcome of stroke, systemic embolism, or death (RR: 0.77, 95% CI: 0.59–1.00; p = 0.05). No significant differences were found for major bleeding (RR: 0.82, 95% CI: 0.56–1.22), all strokes (RR: 0.84, 95% CI: 0.56–1.25), ischemic stroke (RR: 1.15, 95% CI: 0.72–1.85), hemorrhagic stroke (RR: 0.46, 95% CI: 0.11–2.02), systemic embolism (RR: 1.52, 95% CI: 0.36–6.41), or cardiovascular/unexplained death (RR: 0.60, 95% CI: 0.29–1.23). Conclusions LAAC offers a viable alternative to standard anticoagulation in selected AF patients with comparable efficacy and a particular benefit in reducing non–procedure‐related bleeding and mortality advantages.