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Updated: Feb 15, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
WATCHMAN device-related thrombus successfully treated with apixaban: A case report
Chun-Ka Wong1, Pak-Hei Chan, Cheung-Chi Lam
1Cardiology Division, Department of Medicine, The University of Hong Kong Cardiology Center, Hong Kong Sanatorium and Hospital, Happy Valley Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Rationale:
Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus.
Patient Concerns:
A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He was prescribed dual anti-platelet therapy with aspirin and clopidogrel.
Diagnosis:
Reassessment echocardiography 3 months later found device-related thrombus.
Interventions:
The antithrombotic regimen was switched from dual antiplatelet therapy to apixaban.
Outcomes:
Reassessment echocardiography 3 months later revealed complete resolution of the device-related thrombus. Apixaban was stopped. He had dual antiplatelet therapy for 6 more months followed by life-long aspirin. There was no bleeding complication since implantation of Watchman device.
Lessons:
We demonstrated successful treatment of device-related thrombus with a short course of apixaban with complete resolution of thrombus. Further randomized controlled trials are required to determine the choice and duration of drug therapy for device-related thrombus.
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