ABSTRACT NUMBER: ESOC2026A1597 IS LEFT ATRIAL APPENDAGE OCCLUSION SUPERIOR TO ORAL ANTICOAGULATION FOR STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION AND END-STAGE RENAL DISEASE? A META-ANALYSIS

Abstract Background and aims Atrial fibrillation is common in patients with end-stage renal disease (ESRD), however, the optimal stroke prevention modality is unclear. This meta-analysis compares left atrial appendage occlusion (LAAO) to oral anticoagulation (OAC) in stroke prevention and associated bleeding and mortality rates in ESRD adults. Methods A systematic search of major databases was conducted up to December 2025. Analysis was performed using the generic inverse variance method with a random-effects model on RevMan software. Results The analysis incorporated 22,512 patients. LAAO displayed a significantly lower risk of stroke/systemic embolism [Relative Risk (RR): 0.74; 95% Confidence interval (CI): 0.64, 0.86; I^2 = 0%; p= 0.0001], and study-defined Major bleeding [RR: 0.73, 95% CI: 0.57, 0.93; I^2 = 80%; p= 0.01]. Notably, subgroup analysis revealed significantly higher reduction in major bleeding in studies with patients predominantly on warfarin [RR: 0.59, 95% CI: 0.52, 0.67; I^2 = 0%; p< 0.00001] compared to studies with patients predominantly on direct oral anticoagulants [RR: 0.88, 95% CI: 0.77, 0.99; I^2 = 0%; p= 0.04] (p-value for subgroup differences <0.0001). However, there was no significant difference between the interventions in all-cause mortality [RR: 0.8, 95% CI: 0.59, 1.07] or cardiovascular deaths [RR: 0.95, 95% CI: 0.82, 1.11]. Conclusions LAAO is associated with superior stroke prevention compared to OAC in patients with ESRD. While LAAO reduces bleeding risk compared to both warfarin and DOACs, the benefit is most pronounced against warfarin. Future randomized controlled trials comparing LAAO to DOACs and warfarin are recommended. Conflict of interest Zeyad Bady: nothing to disclose, Mahmoud Refaey: nothing to disclose, Ahmed Talkhan: nothing to disclose, Abdullah Al Kahil: nothing to disclose, Ahmed Nasreldein: nothing to disclose.