Short-term oral anticoagulation after left atrial appendage occlusion reduces device-related thrombosis incidence to approximately 1–2% compared with 6–7% with dual antiplatelet therapy without increasing major bleeding, as shown in the ANDES trial with 350 patients.
Does temporary antithrombotic therapy prevent device-related thrombus in patients undergoing percutaneous atrial structural interventions?
Optimal antithrombotic regimens after percutaneous atrial structural interventions remain uncertain and vary widely, highlighting the need for randomized studies and individualized risk-based frameworks.
Percutaneous left atrial appendage occlusion (LAAO), patent foramen ovale (PFO) closure, and atrial septal defect (ASD) closure rely on temporary antithrombotic therapy to prevent device-related thrombus during endothelialization, yet optimal regimens remain uncertain and vary widely across clinical practice. This review synthesizes contemporary evidence on postprocedural antithrombotic strategies, comparing efficacy and safety data and identifying key gaps in knowledge. After LAAO, therapeutic approaches range from short-term anticoagulation with vitamin K antagonists or direct oral anticoagulants to dual or single antiplatelet therapy in patients with high bleeding risk; observational data increasingly support DOAC-based regimens, although device-related thrombus remains a significant concern, and follow-up imaging protocols are inconsistent. Following PFO and ASD closure, antiplatelet-only regimens—typically brief dual antiplatelet therapy followed by aspirin—are widely used, with evidence suggesting that simplified or abbreviated strategies may be sufficient in selected patients. Despite extensive clinical experience, high-quality comparative trials are limited, and optimal therapy, duration, and surveillance remain debated. Standardized imaging definitions, randomized studies, and individualized risk-based frameworks are needed to optimize antithrombotic care after atrial structural interventions.
Pitsikakis et al. (Thu,) conducted a review in Patients undergoing percutaneous left atrial appendage occlusion, patent foramen ovale closure, or secundum atrial septal defect closure. Short-term oral anticoagulation after left atrial appendage occlusion reduces device-related thrombosis incidence to approximately 1–2% compared with 6–7% with dual antiplatelet therapy without increasing major bleeding, as shown in the ANDES trial with 350 patients.