Left atrial appendage occlusion in cancer-associated atrial fibrillation: Who, when, and how to manage antithrombotic therapy

Authors

Ameer Awashra, Department of Medicine, An-Najah National University, Nablus, Palestine.
Ahmed Emara, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohammed AbuBaha, Department of Medicine, An-Najah National University, Nablus, Palestine.
Kareem Istetieh, Department of Medicine, An-Najah National University, Nablus, Palestine.
Shahd Aldarak, Department of Medicine, An-Najah National University, Nablus, Palestine.
Mays Nasser Shaheen, Department of Medicine, An-Najah National University, Nablus, Palestine.
Nouran Alwisi, College of Medicine, QU health, Qatar University, Doha, Qatar.
Bayan Mahafdah, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Bara AbuBaha, Department of Medicine, An-Najah National University, Nablus, Palestine.
Hamza A. Abdul-Hafez, Department of Medicine, An-Najah National University, Nablus, Palestine.
Mohamed S. Elgendy, Faculty of Medicine, Tanta University, Tanta, Egypt.
Abdalhakim Shubietah, Advocate Health - MidwestFollow
Muath Baniowda, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.

Recommended Citation

Awashra A, Emara A, AbuBaha M, et al. Left Atrial Appendage Occlusion in Cancer-Associated Atrial Fibrillation: Who, When, and How to Manage Antithrombotic Therapy. Clin Appl Thromb Hemost. 2026;32:10760296261429249. doi:10.1177/10760296261429249

Affiliations

Advocate Illinois Masonic

Abstract

Background: Cancer-associated atrial fibrillation (AF) is increasingly common, posing dual risks of thrombosis and bleeding. Long-term oral anticoagulation is often limited in these patients due to drug interactions, thrombocytopenia, and treatment-related bleeding. Left atrial appendage occlusion (LAAO) offers a non-pharmacological alternative for stroke prevention, yet its optimal use in cancer remains uncertain.

Methods: We conducted a narrative review of studies from 2009 to October 2025 across PubMed, Embase, and Google Scholar, including randomized trials, observational studies, registries, clinical guidelines, and expert statements addressing LAAO in AF patients, with emphasis on cancer and cardio-oncology populations. Case reports, non-English studies, abstracts without full text, and non-oncologic studies were excluded.

Results: Recent evidence suggests LAAO achieves high procedural success in selected cancer patients and reduces long-term bleeding compared with oral anticoagulants. Post-procedure management typically involves individualized anticoagulant or antiplatelet regimens adjusted for bleeding risk and hematologic status. However, short-term complications may be more frequent, likely reflecting cytopenias and patient frailty.

Conclusion: LAAO represents a promising stroke-prevention strategy for cancer-related AF when anticoagulation is unsafe or ineffective. Optimal outcomes require multidisciplinary evaluation, timing aligned with cancer status, and tailored post-implant antithrombotic therapy. Prospective studies are still needed to define patient selection, procedural timing, and post-procedural management in this high-risk population.

Type

Article

PubMed ID

41824037