Related Experiment Video
Updated: Aug 13, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
"The Failing Watchman": Recurrent Left Atrial Appendage Occlusion Device (LAAOD) Thrombus After Successful Initial
Omar Khan1,2, Antoine Egbe3, Danish Abbasi4
1Internal Medicine, McLaren Macomb Hospital, Mount Clemens, USA.
Insights
This case study highlights challenges in anticoagulation management after Watchman device implantation for atrial fibrillation. Effective anticoagulation is crucial to prevent device-related thrombus and bleeding complications.
Area of Science:
- Cardiology
- Medical Device Technology
- Pharmacology
Background:
- Atrial fibrillation necessitates anticoagulation to prevent stroke.
- Left atrial appendage occlusion devices (LAAODs) offer an alternative to long-term anticoagulation for stroke risk reduction.
- Managing anticoagulation post-LAAOD implantation requires balancing thrombotic and bleeding risks.
Observation:
- A patient with atrial fibrillation experienced bleeding on dabigatran, leading to its discontinuation.
- Following Watchman device implantation, dabigatran was restarted but a large thrombus formed on the device.
- The device thrombus resolved with warfarin (Coumadin) but recurred after its discontinuation.
Findings:
- Recurrent device-related thrombus despite negative hypercoagulable workup.
- Successful resolution of thrombus with warfarin therapy.
- Apixaban (Eliquis) was initiated due to recurrent thrombosis and prior bleeding history, with no further complications.
Implications:
- Optimal anticoagulation strategy post-LAAOD implantation remains a clinical challenge.
- Individualized anticoagulant selection may be necessary to manage device-related thrombosis and bleeding.
- This case underscores the importance of vigilant monitoring and tailored pharmacotherapy in patients with LAAODs.
Abstract:
A 79-year-old female with chronic atrial fibrillation was being treated with dabigatran (Pradaxa). Pradaxa was discontinued after a significant bleeding episode. A WATCHMAN device was successfully implanted and Pradaxa was started. A transesophageal echocardiogram (TEE) 49 days later showed a 3.6×2.2 cm clot overlying the device. Pradaxa was switched to Coumadin. Subsequent TEEs showed the complete resolution of the thrombus after five months on Coumadin. Coumadin was discontinued. Six months later, TEE showed a large mobile thrombus attached to the left atrial appendage occlusion device (LAAOD). The patient's hypercoagulable workup was negative. Due to recurrent thrombotic events, she was started on apixaban (Eliquis) due to a prior history of bleeding on Coumadin. She is currently on Eliquis with no further episodes of bleeding or device thrombus.
