Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions: State-of-the-art review

Atrial septal defect, persistent foramen ovale and the left atrial appendage are nowadays often percutaneously closed with implantable devices. These interventions may be complicated by thromboembolic events and the perfect post-procedural antithrombotic management is still under investigation. The mechanisms leading to left atrial device-related thrombus and thromboembolic complications are not fully understood. Biomarkers of coagulation activation are elevated following percutaneous device placement, peaking within one month and returning to baseline values after three months. By contrast, platelet reactivity shows no post-procedural increase. This suggests that an optimal antithrombotic regimen should perhaps include (oral) anticoagulation therapy rather than the currently more frequently prescribed antiplatelet-based regimen. Furthermore, biomarkers of endothelial activation, fibrinolysis, and on-treatment platelet reactivity may be of value in predicting device-related thrombus and bleeding and guide future medical strategy, facilitating personalized medicine.

Automated summary

Atrial septal defect, persistent foramen ovale, and left atrial appendage can now be closed percutaneously using implantable devices. However, these interventions may lead to thromboembolic events, and the optimal post-procedural antithrombotic management is still uncertain. The mechanisms behind device-related thrombus and thromboembolic complications are not fully understood, but biomarkers of coagulation activation increase while platelet reactivity remains unchanged. This suggests that a regimen including anticoagulation therapy may be more effective than the current antiplatelet-based approach.