In inexperienced operators, incomplete occlusion of the LAA after LARIAT ligation was relatively common (20% of cases) and was associated with risk of No randomized controlled study comparing this device with oral anticoagulation is currently available. In addition, the role of LAAO devices in AF patients also has to consider that no trials are available comparing these devices with NOACs. Thrombus formation on LAAO devices is also not uncommon (as high as 7.2% per year) and is associated with a risk of ischemic stroke during follow-up.458,459 Different surgical techniques have been applied for surgical exclusion of LAA (simple suture ligation, over- sewing of the LAA base without excision, appendage excision or amputation, surgical stapling), but data on TEE during follow-up suggest incomplete occlusion in up These observations and the lack of a clear bene t on stroke prevention evident from an RCT indicate that in patients with AF, these surgical techniques do not currently allow avoidance or interruption of oral anticoagulation in patients at risk of Recommendations 55. In patients with AF at high risk of ischemic stroke who have absolute contraindications for OAC, we suggest using LAA occlusion (Weak recommendation, low quality evidence). Remark: When taking into account LAAO as a potential option, the risk of bleeding related to antiplatelets agents that need to be prescribed in the rst months has to be considered and the possibility to use NOACs. 56. In AF patients at risk of ischemic stroke undergoing cardiac surgery, we suggest considering surgical exclusion of the LAA for stroke prevention, but the need for long-term OAC is unchanged (Weak recommendation, low quality evidence). Surgical Procedures and Interventions: Patients with AF on long-term prophylaxis with OACs may need surgical or interventional procedures that require appropriate management. 