Related Experiment Video
Updated: Oct 14, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Treatment of Device-Related Thrombosis After Left Atrial Appendage Occlusion: Initial Experience With Low-Dose
Eduardo Flores-Umanzor1, Pedro Cepas-Guillen1, Ander Regueiro1
1Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Spain.
Insights
Low-dose apixaban effectively treated device-related thrombosis (DRT) after left atrial appendage closure. This approach prevented bleeding events in high-risk patients, offering a feasible oral antithrombotic therapy option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Left atrial appendage (LAA) closure devices necessitate short-term oral antithrombotic therapy (AT) to prevent device-related thrombosis (DRT) until endothelialization.
- Optimal AT strategies for DRT prevention remain undefined, highlighting a critical gap in clinical practice.
Discussion:
- This case series evaluated the efficacy and safety of low-dose apixaban for managing DRT in patients who underwent LAA closure.
- Patients treated with low-dose apixaban (2.5 mg/12 h) had high CHA2DS2-VASc and HAS-BLED scores and a history of major bleeding events.
Key Insights:
- Eleven patients (6.1%) developed DRT, with four treated using a reduced apixaban dosage.
- No major or minor bleeding complications were observed during the low-dose apixaban treatment period.
- Single antiplatelet therapy was the initial AT strategy before DRT diagnosis in all cases.
Outlook:
- Low-dose apixaban presents a potentially feasible and safe oral antithrombotic therapy option for preventing DRT post-LAA closure.
- Further research is warranted to establish definitive guidelines for AT strategies in DRT management.
Background:
Left atrial appendage (LAA) closure devices require short-term postprocedural oral antithrombotic therapy (AT) to prevent device-related thrombosis (DRT) until device endothelialization occurs. Currently, there is no consensus regarding the optimal AT strategy for DRT prevention.
Methods:
The purpose of our case series is to summarize our experience using apixaban at reduced doses for effectively treating DRT.
Results:
Among a total of 180 patients, 11 patients (6.1%) presented DRT and 4 were specifically treated with low-dose apixaban (2.5 mg/12 h). The mean CHA2DS2-VASc and HAS-BLED scores were high [5 (SD ±1.2) and 3.25 (SD ±0.5), respectively] and all patients had history of a major hemorrhagic event (BARC Score ≥3) mostly gastrointestinal (n = 3). An Amplazer Amulet device was implanted in 3 patients, and a LAmbre system in one patient. AT strategy at the time of DRT diagnosis was consistently single antiplatelet therapy in all patients. Following DRT diagnosis, reduced dose of apixaban was initiated in all the patients. No major or minor bleeding events occurred during apixaban administration.
Conclusions:
Apixaban low dose regimen could be a feasible option to prevent DRT while keeping a low risk of bleeding.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Aneurysm III: Interprofessional Care