Device-Related Thrombosis After Left Atrial Appendage Occlusion: Updated Management and Contemporary Challenges

Vincenzo Paragliola; Emanuele Chiarazzo; Andrea Giovanni Parato; Marcello Marchetta; Stefano Sasso; Giuseppe Massimo Sangiorgi; Andrea Natale; Mario Iannaccone

doi:10.3390/cardiovascmed29020016

April 16, 2026Cardiovascular MedicineOpen Access

Device-Related Thrombosis After Left Atrial Appendage Occlusion: Updated Management and Contemporary Challenges

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Device-related thrombus directly compromises the protective intent of left atrial appendage occlusion, but optimal prevention and treatment regimens, as well as diagnostic imaging surveillance, remain undefined and lack standardization.

Key Points

This review aims to synthesize current evidence on device-related thrombus in left atrial appendage occlusion and its impact on patient outcomes.
Conducted a comprehensive narrative review of contemporary evidence
Examined incidence, mechanisms, predictors, and management of device-related thrombus
Sourced data from observational registries and clinical studies
Analyzed imaging techniques including transesophageal echocardiography and cardiac CT
Device-related thrombus incidence ranges from 1.75% to nearly 5% annually
DRT is linked to increased risks of ischemic stroke, systemic embolism, and mortality
Optimal management strategies for DRT prevention and treatment are not yet defined
Lack of standardization affects diagnostic and surveillance practices

Structured PICO

P

Population

Patients with atrial fibrillation undergoing percutaneous left atrial appendage occlusion (LAAO)

I

Intervention

Management and surveillance of device-related thrombus (DRT) after left atrial appendage occlusion

O

Outcome

Incidence, mechanisms, predictors, clinical impact, and management of device-related thrombus (DRT)

Implication

This review highlights that device-related thrombus after LAAO occurs in 1.75% to 5% of cases annually and is associated with increased stroke and mortality, emphasizing the need for standardized surveillance and management.

Abstract

Percutaneous left atrial appendage occlusion (LAAO) has become an established alternative to long-term oral anticoagulation for stroke prevention in patients with atrial fibrillation, with expanding indications beyond those with absolute contraindications to anticoagulation. Alongside its broader adoption, device-related thrombus (DRT) has emerged as a clinically relevant complication that directly compromises the protective intent of LAAO. This comprehensive narrative review synthesizes contemporary evidence on the incidence, mechanisms, predictors, clinical impact, and management of DRT. DRT is a multifactorial phenomenon that carries an annual incidence ranging from 1.75% to almost 5%, resulting from the interplay between post-implant flow dynamics, device engineering, endothelialization processes, procedural factors, and patient-specific prothrombotic features. Accumulating data from observational registries links DRT to increased risks of ischemic stroke, systemic embolism, major adverse cardiovascular events (MACE), and mortality. Although evidence is growing, optimal management regimens for both the prevention and treatment of DRT remain undefined. Moreover, a lack of standardization also affects diagnosis and imaging surveillance, mainly performed by transesophageal echocardiography or cardiac computed tomography. By integrating mechanistic insights, clinical predictors, device-specific considerations, and therapeutic evidence, this review highlights current knowledge gaps and proposes practical considerations to inform individualized risk stratification, surveillance, and management of DRT in contemporary LAAO practice.