# Antithrombotic Therapy in Percutaneous Atrial Structural Interventions

## TL;DR

This paper reviews the best ways to use blood thinners after heart procedures to prevent clots, highlighting current practices and research gaps.

## Contribution

The paper provides a synthesis of current evidence and identifies gaps in antithrombotic therapy strategies after atrial structural interventions.

## Key findings

- Observational data increasingly support DOAC-based regimens after LAAO.
- Antiplatelet-only regimens are commonly used after PFO and ASD closure.
- High-quality comparative trials are limited, and optimal therapy remains debated.

## Abstract

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.