LAAC Noninferior to DOACs in High-Risk Atrial Fibrillation

PRAGUE-17 is the first randomized head-to-head comparison of left atrial appendage closure against direct oral anticoagulants in atrial fibrillation patients at elevated stroke and bleeding risk, extending device evidence beyond the warfarin era.

left atrial appendage closureLAACdirect oral anticoagulantsDOACapixabanatrial fibrillationstroke preventionbleedingPRAGUE-17noninferiority trialanticoagulation Cardiology / Anticoagulation

Background Information

LAAC proves noninferior to DOACs in high-risk AF stroke prevention.

Determining effective and safer alternatives for stroke prevention in atrial fibrillation (AF) patients at high risk of bleeding is crucial. The study found that left atrial appendage closure (LAAC) is noninferior to direct oral anticoagulants (DOACs) in preventing major adverse events in high-risk AF patients. LAAC may be considered as an alternative to DOACs for patients who are at high risk of stroke and bleeding, given its comparable efficacy and safety profile. LAAC offers a valid option to DOACs for high-risk AF patients with similar efficacy.

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Authors: Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, Poloczek M, Stasek J, Haman L, Branny M, Chovancik J, Cervinka P, Holy J, Kovarnik T, Zemanek D, Havranek S, Vancura V, Opatrny J, Peichl P, Tousek P, Lekesova V, Jarkovsky J, Novackova M, Benesova K, Widimsky P, Reddy VY, PRAGUE-17 Trial Investigators

Citation: Osmancik P, Herman D, Neuzil P, et al. Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2020;75(25):3122-3135. doi:10.1016/j.jacc.2020.04.067

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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