A Very Late and Persistent Thrombosis after Left Atrial Appendage Occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Research

Background:

• Atrial fibrillation (AF) is a common arrhythmia, with ischemic stroke as its major complication.
• Left atrial appendage (LAA) occlusion offers an alternative to oral anticoagulation for stroke prevention in patients with bleeding risks.
• Device-related thrombosis is a known but infrequent complication of LAA occlusion.

Observation:

• A case of very late thrombosis of a left atrial appendage occluder device is presented.
• The thrombosis was diagnosed after the patient experienced a stroke.
• Initial treatment with apixaban or warfarin alone failed to resolve the thrombus.

Findings:

• Successful regression of the LAA occluder thrombus was achieved using a combination of high-dose warfarin and aspirin (100mg/day).
• This case highlights a rare complication of LAA occlusion, emphasizing the need for vigilant monitoring.
• Incomplete endothelialization of the LAA occluder device is proposed as a potential etiology for this late thrombosis.

Implications:

• This finding suggests that combination therapy may be necessary for managing LAA occluder thrombosis in select cases.
• Understanding the mechanisms of incomplete endothelialization is crucial for improving LAA device safety and efficacy.
• Further research into optimal anticoagulation strategies and long-term device surveillance after LAA occlusion is warranted.