<p>The link between heart failure (HF) and increased prothrombotic risk has gathered attention, with several studies exploring this association. Patients with HF and severe mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) may present enhanced left atrial (LA) function and improve thrombosis-related factors due to the procedure. This study investigates the role of left atrial strain (LAS), assessed via speckle-tracking echocardiography, in detecting subtle LA abnormalities and its potential link to thrombotic risk in severe MR patients. 31 consecutive patients with severe MR who underwent TEER were enrolled. Six patients were lost to follow-up, and 25 completed both visits (V1 and V2). Coagulation parameters (thrombin generation, clot permeation [Ks], clot lysis time [CLT]) and echocardiographic assessments were performed at each visit. Subgroup analysis was also done for patients with sinus rhythm and atrial fibrillation. A significant correlation was found between LAS-r and changes in CLT (<i>p</i> = 0.03; <i>R</i> = -0.43) before and after TEER. LAS-cd decreased, and LAS-ct increased. No significant differences were noted in coagulation parameters. Patients with sinus rhythm also showed a significant correlation with CLT changes. This study demonstrates significant changes in LAS after TEER, with reduced LAS-cd and increased LAS-ct, which highlights a potential link between cardiac mechanics and clotting properties, with distinct differences between patients with sinus rhythm and atrial fibrillation. These findings provide insights into cardiac and thrombotic changes post-TEER, requiring further investigation.</p> Graphical abstract <p></p>