LAA Closure Shows Noninferiority to NOACs in AFib, with Less Bleeding (CHAMPION-AF)
In CHAMPION-AF, patients with nonvalvular AFib eligible for long-term anticoagulation were randomized to left atrial appendage closure with the WATCHMAN FLX device versus NOAC therapy. Over three years, LAA closure met noninferiority for the composite endpoint of ischemic/hemorrhagic stroke, cardiovascular death, and systemic embolism (5.7% vs 4.8%), with a slight uptick in ischemic strokes but substantially less non-procedural bleeding (10.9% vs 19%); secondary analyses showed fewer major/nonmajor bleeding events with closure. The trial supports LAA closure as a reasonable alternative to NOACs in selected patients, though longer-term data are needed and shared decision-making remains important; editors caution that results do not yet support replacing NOACs broadly.
