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Updated: Jun 12, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
When Anticoagulation Matters: A Case of Large Left Atrial Thrombus After Left Atrial Appendage Ligation
Emmanuel Fohle1, Natale Wasef1, Filip Oleszak1
1Cardiovascular Disease Fellowship Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Insights
Surgical ligation of the left atrial appendage (LAA) for atrial fibrillation (AF) can lead to thrombus formation. This case highlights the need for clear guidelines on anticoagulation post-LAA ligation to prevent serious complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia linked to stroke.
- The CHAD2DS2-VASc score guides anticoagulation decisions.
- Left atrial appendage (LAA) ligation is an alternative for high-risk patients, but post-procedure management is unclear.
Abstract:
Atrial fibrillation (AF) is the most frequently encountered arrhythmia in the clinical practice and is associated with stroke. In clinical practice, CHAD2DS2-VASc score is used as a tool to decide whether anticoagulation is needed. In those patients with high bleeding risk or falls, surgical ligation of the left atrial appendage (LAA) or percutaneous closure devices are strategies used to mitigate these challenges. However, there is no guideline advising on what patient's specific factors should be considered in determining initiation or continuation of anticoagulation post LAA ligation. Herein, we report the case of a patient with surgical ligation who developed large atrial thrombus requiring emergent median sternotomy.
