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Antithrombotic Therapy and Device-Related Thrombosis Following Endovascular Left Atrial Appendage Closure

Jacqueline Saw1, Jens Erik Nielsen-Kudsk2, Martin Bergmann3

  • 1Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.

JACC. Cardiovascular Interventions
|May 20, 2019
PubMed

Insights

Antithrombotic therapy after left atrial appendage closure (LAAC) is crucial for stroke prevention. Device-related thrombosis is a risk, necessitating careful management and surveillance post-LAAC.

Area of Science:

  • Cardiology
  • Medical Devices
  • Thrombosis Research

Background:

  • Left atrial appendage closure (LAAC) is a growing procedure for stroke prevention in nonvalvular atrial fibrillation patients.
  • It is particularly important for individuals unable to tolerate or ineligible for oral anticoagulation.
  • Understanding post-procedural management is key to optimizing outcomes.

Purpose of the Study:

  • To review current evidence on antithrombotic therapy following LAAC.
  • To assess the risk of device-related thrombosis (DRT) after LAAC.
  • To discuss therapeutic options and rationale for antithrombotic strategies post-LAAC.

Main Methods:

  • Systematic review of existing literature on antithrombotic therapy and DRT after LAAC.
  • Analysis of current clinical practices and physician-dependent choices in antithrombotic regimens.
  • Evaluation of patient-specific bleeding risk factors influencing therapeutic decisions.

Main Results:

  • Device-related thrombosis is a significant complication of LAAC, with unclear etiology.
  • Real-world data suggests dual-antiplatelet therapy or direct oral anticoagulation may be comparable to warfarin and aspirin for safety and DRT occurrence.
  • Routine device imaging surveillance is recommended to detect DRT, which requires aggressive treatment due to high thromboembolic risks.

Conclusions:

  • There are uncertainties and dilemmas regarding optimal antithrombotic therapy post-LAAC.
  • The study provides an in-depth discussion on available options and the rationale for their use.
  • Aggressive management of diagnosed DRT is essential to mitigate thromboembolic risks.
Abstract

Keywords:
atrial fibrillationdevice-related thrombusleft atrial appendage closure

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