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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Overcoming NOAC-resistant left atrial appendage thrombus in atrial fibrillation: clinical gaps and therapeutic

Klaudia Vivien Nagy1, Bence Arnóth1, Ferenc Komlósi1

  • 1Heart and Vascular Center, Semmelweis University, Budapest, Hungary.

Frontiers in Cardiovascular Medicine
|October 13, 2025
PubMed

Insights

Patients with atrial fibrillation (AF) may develop left atrial appendage (LAA) thrombi despite optimal anticoagulation. Modifying antithrombotic therapy may improve thrombus resolution, but further research is needed.

Area of Science:

  • Cardiology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) is a common arrhythmia linked to stroke.
  • The left atrial appendage (LAA) is a primary site for thrombus formation in AF.
  • Current guidelines recommend oral anticoagulants (OACs), with NOACs often preferred over VKAs.

Purpose of the Study:

  • To review the current evidence on managing LAA thrombi in AF patients on OACs.
  • To highlight limitations in current guidelines and clinical practice.
  • To propose future research directions for this clinical dilemma.

Main Methods:

  • Mini-review of existing literature and retrospective cohort analyses.
  • Summary of evidence regarding antithrombotic therapy in LAA thrombus resolution.
  • Discussion of current guidelines and their limitations.

Main Results:

  • A subset of AF patients develop LAA thrombi despite optimal OAC therapy.
  • Retrospective data suggest modifying antithrombotic regimens may aid thrombus resolution.
  • No prospective trials currently define the optimal management strategy.

Conclusions:

  • Managing LAA thrombi in AF patients on anticoagulation remains an underrecognized clinical challenge.
  • Further prospective research is crucial to establish optimal antithrombotic strategies.
  • Addressing this gap is essential for improving patient outcomes and preventing thromboembolic events.

Keywords:
NOAC resistanceVKA therapyantithrombotic strategyatrial fibrillationleft atrial appendage thrombusoral anticoagulation

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