The optimal antithrombotic therapy (ATT) regimen to prevent device-related thrombosis (DRT) while not increasing bleeding risk after percutaneous left atrial appendage occlusion (LAAO) is unclear. Substantial practice variation within the United States and worldwide is well documented, revealing considerable clinical equipoise.1 The US Food and Drug Administration approval of the Watchman device was based on randomized clinical trials (RCTs) that compared LAAO to warfarin; LAAO was accompanied by short-term warfarin, followed by dual antiplatelet therapy (DAPT) and indefinite aspirin. In the PRAGUE-17 RCT (), the Amulet and Watchman LAAO devices were compared with a direct-acting anticoagulant (DOAC).2 Again, DAPT followed by aspirin was primarily used in the LAAO group.3 With emerging observational data supporting the relative efficacy and safety of DOAC in patients receiving LAAO, there is growing interest in low-dose DOAC as an alternative to DAPT. In this context, the RCT reported by Freixa et al4 provides initial data comparing low-dose DOAC to DAPT following LAAO.