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Updated: Feb 14, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Multiple Thromboembolic Events from a Left Atrial Appendage Occlusion Device
Graeme Prosperi-Porta1, Gregory Schnell2, Jillian Colbert2
1Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Left atrial appendage occlusion devices offer stroke risk reduction in atrial fibrillation. A case highlights incomplete device healing leading to fatal clots, underscoring the need for optimal post-procedure care.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Left atrial appendage occlusion (LAAO) devices are alternatives to anticoagulation for stroke prevention in nonvalvular atrial fibrillation (NVAF).
- Post-implantation thromboprophylaxis is recommended, but optimal regimens remain undefined.
Observation:
- A patient experienced multiple thromboembolic events following LAAO device implantation.
- A clinicopathologic examination revealed thrombus formation on an incompletely endothelialized WATCHMAN device.
Findings:
- Incomplete endothelialization of the WATCHMAN device was associated with adherent thrombus.
- The thrombus contributed to recurrent thromboembolic events, leading to a fatal outcome.
Implications:
- This case highlights critical uncertainties in the endothelialization process of LAAO devices.
- Further research is needed to establish optimal thromboprophylaxis strategies after LAAO implantation to prevent device-related thrombosis.
Abstract:
Left atrial appendage occlusion devices are an alternative to oral anticoagulation in patients with nonvalvular atrial fibrillation who are at risk of ischemic stroke. Thromboprophylaxis after implantation is recommended, but the optimal regimen is unknown. We report a clinicopathologic case in which thrombus adherent to an incompletely endothelialized WATCHMAN device (Boston Scientific, Marlborough, MA) resulted in multiple thromboembolic events, contributing to a fatal outcome. This case illustrates uncertainties regarding the device's endothelialization process.
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