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Antithrombotic Therapy in Percutaneous Atrial Structural Interventions.

Konstantinos Pitsikakis1, Ioannis Skalidis2, Emmanuel Skalidis1

  • 1Department of Cardiology, University Hospital of Heraklion, Voutes, Leof Panepistimiou, 71500 Iraklio, Greece.

Journal of Cardiovascular Development and Disease
|March 27, 2026
PubMed
Summary

Optimal antithrombotic strategies after left atrial appendage occlusion (LAAO), patent foramen ovale (PFO), and atrial septal defect (ASD) closure are uncertain. Evidence synthesis highlights inconsistent practices and the need for standardized, individualized approaches to prevent device-related thrombus.

Keywords:
anticoagulant therapyantiplatelet therapyatrial septal defect closureleft atrial appendage occlusionpatent foramen ovale closurepostprocedural antithrombotic strategies

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Thrombosis

Background:

  • Percutaneous closure of left atrial appendage (LAAO), patent foramen ovale (PFO), and atrial septal defect (ASD) require antithrombotic therapy to prevent device-related thrombus during healing.
  • Current antithrombotic regimens are inconsistent across clinical practices, lacking standardized protocols.

Purpose of the Study:

  • To review and synthesize current evidence on postprocedural antithrombotic strategies for LAAO, PFO, and ASD closure.
  • To compare the efficacy and safety of different antithrombotic regimens.
  • To identify knowledge gaps and areas for future research.

Main Methods:

  • Systematic review of contemporary evidence on antithrombotic therapies post-LAAO, PFO closure, and ASD closure.
  • Comparison of efficacy and safety data from observational studies and limited clinical trials.
  • Analysis of current clinical practice variations and surveillance protocols.

Main Results:

  • For LAAO, direct oral anticoagulants (DOACs) show promise, but device-related thrombus remains a concern, and imaging protocols vary.
  • For PFO and ASD closure, antiplatelet-only strategies (dual then single) are common, with potential for simplified or abbreviated regimens.
  • High-quality comparative trials are scarce, leading to ongoing debate on optimal therapy, duration, and surveillance.

Conclusions:

  • Optimal antithrombotic therapy, duration, and surveillance post-atrial structural interventions remain debated.
  • Standardized imaging definitions, robust randomized trials, and individualized risk-based frameworks are crucial for optimizing patient care.
  • Further research is needed to establish evidence-based, personalized antithrombotic strategies.