Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Oct-Dec;20(4):175-177.
doi: 10.4103/HEARTVIEWS.HEARTVIEWS_57_19. Epub 2019 Nov 14.

A Very Late and Persistent Thrombosis after Left Atrial Appendage Occlusion

Theodoros Sinanis  1
Affiliations
Case Reports

A Very Late and Persistent Thrombosis after Left Atrial Appendage Occlusion

Theodoros Sinanis. Heart Views. 2019 Oct-Dec.

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia and ischemic stroke represents the most important complication. When the oral anticoagulation cannot be taken due to bleeding problems and considerations, the percutaneous occlusion of the left atrial appendage (LAA) is a possible solution. We present a case of a very late thrombosis of the LAA-Occluder device. The thrombus was diagnosed only after the patient suffered a stroke and a regression could not be achieved, neither with apixaban nor with warfarin alone. A successful result could be observed with the combination of high dose warfarin with aspirin 100mg/day. The possible etiology of this rare complication is an incomplete endothelialization of the device.

Keywords: Atrial fibrillation; left atrial appendage occluder; thrombosis.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transoesophageal echocardiography shortly after the presentation with stroke and over 4 years after the implantation of the left atrial appendage occlude (a) and transoesophageal echocardiogram after initiation of a combination therapy with warfarin and aspirin (b), showing regression of the device-related thrombosis. Red arrow is the thrombosis
See this image and copyright information in PMC

References

    1. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ, et al. Validation of clinical classification schemes for predicting stroke: Results from the national registry of atrial fibrillation. JAMA. 2001;285:2864–70. - PubMed
    1. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial. Lancet. 2009;374:534–42. - PubMed
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609–78. - PubMed
    1. Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Abbey S, et al. Device-related thrombosis after percutaneous left atrial appendage occlusion for Atrial Fibrillation. J Am Coll Cardiol. 2018;71:1528–36. - PubMed
    1. Dukkipati SR, Kar S, Holmes DR, Doshi SK, Swarup V, Gibson DN, et al. Device-related thrombus after left atrial appendage closure. Circulation. 2018;138:874–85. - PubMed

Publication types