In patients with atrial fibrillation at high risk for stroke and bleeding, percutaneous left atrial appendage closure (LAAC) was noninferior to non-vitamin K oral anticoagulants (NOACs) in a multicentre trial.

Czech clinicians randomised 402 patients with atrial fibrillation at high risk for both stroke and bleeding (mean age 73, about 65% men) to either a NOAC (96% apixaban) or LAAC with either a watchman or amulet device.

The primary composite outcome was stroke, transient ischemic attack (TIA), systemic embolism, cardiovascular death, clinically relevant bleeding, or procedure-/device-related complications.

As reported in the Journal of the American College of Cardiology, the LAAC procdure was successful in 90% of patients in that arm of the trial.