Left Atrial Appendage Closure Complicated by Spinal Epidural Hematoma and Device-Related Thrombosis: A Case Report

Left atrial appendage closure (LAAC) is an important approach for stroke prevention in patients with non-valvular atrial fibrillation. Anticoagulation-related spinal epidural hematoma (SEH) and device-related thrombosis (DRT) are rare but serious complications.

We report the case of an 86-year-old female who presented with a six-month history of recurrent chest tightness. She was clinically diagnosed with persistent non-valvular atrial fibrillation and chronic heart failure. Following a comprehensive evaluation, she underwent successful LAAC and was started on edoxaban 30 mg once daily for anticoagulation. At six weeks post-procedure, she developed an anticoagulation-related SEH. Anticoagulation was immediately discontinued. Following conservative management, the hematoma resolved and her muscle strength improved. She was subsequently started on clopidogrel 75 mg once daily for antiplatelet therapy. At the six-month follow-up, transthoracic echocardiography and computed tomography angiography confirmed a large DRT in the left atrium. Anticoagulation was re-initiated with low-molecular-weight heparin bridging to warfarin, with the international normalized ratio maintained between 2.0 and 2.5. Follow-up imaging at eight months demonstrated significant resolution of the left atrial thrombus. During the remainder of the follow-up period, no further major adverse events, including ischemic stroke or bleeding, occurred.

For patients with multiple high-risk factors undergoing LAAC, attention should be paid to dynamic adjustment of individualized antithrombotic strategies, enhancement of perioperative procedural quality control, and structured follow-up within key time windows, in order to minimize the risk of complications and optimize the net clinical benefit.