Transcatheter aortic valve implantation (TAVI) and left atrial appendage occlusion (LAAO) have resulted in a great advancement in the management of cardiovascular disease, specifically, structural heart disease. Nonetheless, addressing the antithrombotic treatment requirements of patients at high risk of bleeding after undergoing these procedures can be a challenge. TAVI, a procedure employed for the percutaneous treatment of aortic stenosis, carries a potential risk of thromboembolic events. Conversely, LAAO, designed to reduce the risk of stroke in patients with atrial fibrillation, involves the placement of a device within the left atrial appendage, primarily for individuals who cannot tolerate anticoagulation. In both scenarios, the critical consideration revolves around devising the most suitable antithrombotic strategy for patients with an elevated risk of bleeding. This involves conducting a comprehensive evaluation of each patient’s unique bleeding and thrombotic risk profile. Collaborative decision-making and diligent monitoring constitute the essential components for optimizing antithrombotic therapy in high-bleeding-risk patients who have undergone TAVI or LAAO procedures. Furthermore, customized approaches, such as the utilization of aspirin alone, may be considered in specific situations.