DEVICE-BASED left atrial appendage closure can match standard anticoagulants for preventing stroke and cardiovascular events in patients with atrial fibrillation (AF), while significantly reducing bleeding risk, according to a large international trial.
AF is a common heart rhythm disorder that increases the risk of stroke due to clot formation, typically managed with long-term anticoagulation therapy.
However, bleeding complications remain a major limitation of this approach, prompting interest in alternative strategies such as left atrial appendage closure.
Atrial Fibrillation Treatments Show Comparable Effectiveness
In this phase III randomised trial of 3,000 patients with AF who were eligible for anticoagulation, researchers compared device-based left atrial appendage closure with non–vitamin K antagonist oral anticoagulants (NOACs).
Participants had a mean age of 71.7 years, and a moderate-to-high stroke risk, reflected by a mean CHA₂DS₂-VASc score of 3.5.
After three years, the primary composite outcome of cardiovascular death, stroke, or systemic embolism occurred in 5.7% of patients in the device group compared with 4.8% in the anticoagulation group (difference: 0.9 percentage points; 95% CI: −0.8–2.6; p<0.001 for noninferiority).
These findings confirmed that this atrial fibrillation treatment was noninferior to standard anticoagulation therapy in preventing major cardiovascular events.
Reduced Bleeding Risk with Device Strategy
Importantly, the safety profile favoured the device-based approach.
Non–procedure-related bleeding occurred in 10.9% of patients receiving left atrial appendage closure versus 19.0% of those on anticoagulants (hazard ratio: 0.55; 95% CI: 0.45–0.67; p<0.001).
This represents a substantial reduction in bleeding risk, one of the most significant complications associated with long-term anticoagulation.
The study was prospective and international, strengthening the generalisability of the findings. However, as an ongoing trial, longer follow-up will be needed to confirm durability of benefit and assess rare adverse events related to device implantation.
Implications for Clinical Practice
These results suggest that device-based AF treatment could become a viable alternative not only for patients unsuitable for anticoagulation, but also for those currently managed with it.
Reducing bleeding risk while maintaining stroke prevention is a key goal in AF management.
Future research will help clarify which patients are most likely to benefit from this approach, and whether broader adoption could reshape standard care pathways for AF.
Reference
Doshi SK et al.; CHAMPION-AF Investigators. Left atrial appendage closure or anticoagulation for atrial fibrillation. N Engl J Med. 2026;DOI:10.1056/NEJMoa2517213.
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