Left Atrial Appendage Occlusion in Cancer-Associated Atrial Fibrillation: Who, When, and How to Manage Antithrombotic Therapy.

Abstract

BackgroundCancer-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.MethodsWe 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.ResultsRecent 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.ConclusionLAAO 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.