Antithrombotic management in left sided- ablation and appendage device-closure procedures.

Atrial fibrillation is the most prevalent sustained cardiac arrhythmia, and the therapeutic landscape for stroke prevention has expanded to include catheter ablation for rhythm control and left atrial appendage closure in patients unsuitable for long-term oral anticoagulation. Although minimally invasive, these interventions present complex thrombotic challenges. The left atrial and appendage environment is inherently prothrombotic due to structural remodeling, endothelial injury, blood stasis, and abnormal hemostasis-processes further amplified by procedural instrumentation such as transseptal puncture during left-sided ablation and structural interventions. Antithrombotic management requires a balance between thromboembolic prevention and bleeding risk. Pre-procedural imaging with transesophageal echocardiography or cardiac computed tomography remains essential for thrombus detection and risk stratification peri-procedurally. Direct oral anticoagulants provide pharmacokinetic advantages over vitamin K antagonists, including shorter half-lives and greater predictability, thereby facilitating periprocedural management. Post-procedural therapy must be individualized on the basis of stroke risk, device-related findings, and patient-specific characteristics. This review synthesizes current evidence on antithrombotic strategies in the setting of left-sided cardiac interventions.