Articles Tập 67 Số CĐ13-HNKH Bệnh viện 19-8 10/09/2026

TRANSCATHETER LEFT ATRIAL APPENDAGE OCCLUSION FOR STROKE PREVENTION IN NON-VAL

Hùng Phạm Mạnh, Phong Phan Đình, Niên Dương Hồng, Bảng Đỗ Kim, Kiên Lê Võ, Minh Phạm Nhật, Nghĩa Phan Đình, Đạt Lê Van
DOI: 10.52163/yhc.v67iCD13.6391
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Keywords
non-valvular atrial fibrillation; left atrial appendage occlusion; LAAO; CHAMPION-AF; CLOSURE-AF; OPTION; ANDES; device-related thrombus; peridevice leak; oral anticoagulation.
Abstract

Background and Objectives: Left atrial appendage occlusion (LAAO) is evolving beyond its initial role—as a stroke prevention strategy reserved for patients with non-valvular atrial fibrillation (NVAF) who have contraindications to anticoagulation—to become an option for a broader patient population. This article provides an update (through July 2026) on device advancements, evidence from the latest randomized controlled trials (RCTs), and unresolved issues.
Methods: This is a narrative review rather than a systematic review. We searched PubMed, Cochrane, Google Scholar, and conference proceedings (ACC, AHA, ESC, TCT) covering the period from 2009 to July 2026, prioritizing RCTs, meta-analyses, large registries, and guidelines; conference data were cross-referenced with full-text publications.
Results: Three RCTs published in the *New England Journal of Medicine* play a pivotal role: OPTION (n≈1,600) demonstrated that LAAO following ablation was non-inferior to anticoagulation and resulted in reduced bleeding; CHAMPION-AF (n=3,000) showed LAAO was non-inferior to NOACs regarding efficacy (5.7% vs. 4.8%) and superior regarding non-procedural bleeding (10.9% vs. 19.0%), although total major bleeding—including peri-procedural events—was comparable; meanwhile, CLOSURE-AF (n=912) failed to meet the non-inferiority criterion compared to medical therapy in a very-high-risk cohort (P=0.44). Additionally, the ANDES trial (n=510) indicated that short-term anticoagulation was safer than dual antiplatelet therapy, and the 2025 SCAI/HRS guidelines issued eight recommendations based on the GRADE methodology. Conclusion: The role of LAAO is expanding among selected patient populations, yet its benefits depend significantly on appropriate patient selection and the center's experience. It is crucial to distinguish between patients with contraindications to anticoagulation and those eligible for DOACs, while simultaneously building a body of data specific to Vietnam.

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