OPTION
Comparison of Anticoagulation With Left Atrial Appendage Closure After Atrial Fibrillation Ablation
Patient / Population Intervention / Exposure Comparison Outcome
In 1,600 patients with atrial fibrillation who underwent catheter ablation, left atrial appendage closure was non-inferior for death, stroke, or systemic embolism and reduced bleeding compared with oral anticoagulation.
N
1,600
Design
Multicentre open-label RCT (dual primary: efficacy non-inferiority, safety superiority)
Endpoint
Efficacy: all-cause death, stroke, or systemic embolism; Safety: non-procedural major or CRNM bleeding
Relevance
2
ResultEfficacy 5.3% vs 5.8% at 36 months (non-inferior; P<0.001). Bleeding 8.5% vs 18.1% (superior for LAA closure; P<0.001).
Wazni OM, et al. N Engl J Med. 2025;392(13):1277-1287. 10.1056/NEJMoa2408308
Discussion & critique
Open-label design and a bleeding endpoint driven partly by anticoagulation exposure temper interpretation. Supports LAA closure as an alternative to continued anticoagulation after AF ablation in patients at bleeding risk.