EuroPCR 2026 – Outcomes with left atrial appendage closure vs. direct oral anticoagulants in patients with atrial fibrillation across different age groups

Background 

For patients with atrial fibrillation (AF), the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure (LAAC) is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. Earlier this year, results were published from the CHAMPION-AF trial comparing device-based LAAC with direct oral anticoagulant (DOAC) therapy among patients with AF who were candidates for anticoagulation.1 The primary efficacy endpoint of death from cardiovascular causes, stroke or systemic embolism at 3 years was noninferior for LAAC vs. DOAC therapy, while LAAC was superior to DOAC for the primary safety endpoint of non-procedure-related bleeding at 3 years. 

Jens Erik Nielsen-Kudsk presented results from a prespecified sub analysis of the CHAMPION-AF trial, which evaluated the efficacy and safety of LAAC vs. DOAC by age. 

Results 

• The analysis included data from 1,915 patients aged <75 years and 1,085 patients aged ≥75 years. 
• The incidence of the primary efficacy endpoint of death from cardiovascular causes, stroke or systemic embolism at 3 years was similar for LAAC vs. DOAC in patients aged <75 years (hazard ratio [HR] 1.07; 95% confidence interval [CI] 0.67–1.71; log rank p=0.7789) and ≥75 years (HR 1.34; 95% CI 0.85–2.12; log rank p=0.2036; p interaction=0.5014). 
• Significantly lower incidence of non-procedural major and clinically relevant non-major bleeding was observed with LAAC vs. DOAC in patients aged <75 years (HR 0.64; 95% CI 0.50–0.82; log rank p<0.0001) and ≥75 years (HR 0.68; 95% CI 0.51–0.91; log rank p=0.0002; p interaction=0.7281). 
• In the intention-to-treat analysis, the incidence of ischaemic stroke was higher in LAAC vs. DOAC, but this difference was no longer significant among patients who received their assigned therapy as intended. 
• Rates of disabling ischaemic stroke were very low and similar across treatment arms and age groups.  

 Key learnings 

• These results indicate that the efficacy and safety of LAAC vs. DOAC are not affected by age. 

Conclusions and PCR recommendations 

These findings suggest that age alone should not preclude the use of LAAC in otherwise suitable candidates. It should be noted that caution is needed when interpreting subgroup analyses as they are associated with certain limitations including reduced power compared with the overall analysis. The choice between LAAC and DOAC should be made on an individualised basis in a shared decision-making process with patients. 

References 

1. Doshi SK, Kar S, Nair DG, et al. Left atrial appendage closure or anticoagulation for atrial fibrillation. N Engl J Med. 2026 Mar 28. doi: 10.1056/NEJMoa2517213. Online ahead of print. 

NOTES TO EDITORS 

Key information

• Session: Hotline / Late Breaking Trials: Major Late-Breaking Trials from EuroPCR 2026 
• Presentation: Outcomes of LAA closure vs. NOAC in patients with atrial fibrillation across different age groups 
• Presenter: Jens Erik Nielsen-Kudsk 
• Palais des Congrès Porte Maillot – Paris, France 
• 20 May 2026 09:45 − 10:45 Theatre Bleu 

About EuroPCR 2026

The world-leading course in interventional cardiovascular medicine will take place from 19 to 22 May 2026, onsite at the Palais des Congrès, Paris, France. A digital package is also available for those unable to join in person.

The detailed programme is available here: www.pcronline.com/Courses/EuroPCR/Programme/2026/Course-programme

About PCR

The mission of PCR is to serve the needs of each individual patient by helping the cardiovascular community to share knowledge, experience and practice. PCR offers a large range of many other educational meetings and resources for the continuing education of the interventional cardiovascular community. These include major annual courses across the globe, e-Learning with high-profile PCR Webinars, courses specifically dedicated to valvular heart disease, tailor-made PCR Seminars on specific topics, online resources and medical publications such as EuroIntervention.

Gateways to all PCR activities are available on www.pcronline.com.
For further information, please contact Sally Collingridge: [email protected]

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