Thrombus on ASD Closure Device Reveals Underlying Thrombophilia

Transcatheter closure of atrial septal defects (ASDs) is indicated to prevent paradoxical embolism, and major complications are uncommon. However, even a small risk of thrombus formation can be amplified by an underlying thrombophilia.

A 25-year-old woman with a history of embolic stroke underwent transcatheter ASD closure. Three years later, she presented with another stroke and was found to have thrombus on the closure device. She was started on long-term anticoagulation, and follow-up imaging showed resolution of the thrombus. Further evaluation revealed antiphospholipid syndrome, an autoimmune thrombophilia.

This case highlights the importance of ruling out hypercoagulable conditions in patients with a thromboembolic event such as a stroke before ASD closure. In patients with underlying thrombophilia, a closure device may increase the risk of thrombus formation and contribute to future embolic events rather than preventing them.

Thorough thrombophilia screening should be considered before ASD closure in patients with embolic stroke. Undiagnosed hypercoagulable states may increase the risk of late-onset device-related thrombosis.