Device-Related Thrombosis After Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation

Abstract

Thrombus formation on the device is not uncommon in patients with AF who are treated by LAA closure. Such events are strongly associated with a higher risk of ischemic stroke during follow-up. (REgistry on Real-Life EXperience With Left Atrial Appendage Occlusion [RELEXAO]; NCT03279406).

Efficacy of Ischemic Stroke Prevention in Patients With Implanted Occluder of the Left Atrium. Five Year Follow-Up

“…Тромбоз предсердной поверхности окклюзирую-щего устройства является достаточно частым ослож-нением процедуры [14], однако в большинстве слу-чаев эффективно разрешается временной коррек-цией медикаментозной терапии и в редких случаях приводит к тромбоэмболическому событию. Тем не менее, ранее было показано, что среди пациентов с развившимся послеоперационным тромбозом риск тромбоэмболического события ожидаемо выше, нежели в группе без такого [15].…”

Secondary prevention of ischaemic stroke

“…The use of at least 6 months of warfarin after LAA occlusion was common in the trials and thus a contraindication to anticoagulation was a trial exclusion criterion. Second, detection of a device related thrombus is difficult and registry data suggest incidence rates which vary from 5% to 25%, depending on the device and post‐insertion antithrombotic regimen . Finally, there are no data to compare LAA occlusion to DOAC with respect to long‐term haemorrhagic stroke risk.…”

The point of no return for percutaneous left atrial appendage closure: Towards to CHA2DS2‐VALAAc Score?

“…Despite all, the DRT after LAAc is not frequent (3.7‐7.2%) but is associated with a higher rate of stroke and systemic embolism . Among those known to have DRT, the adjusted risk for stroke or systemic embolism was more than tripled compared with the risk without DRT . DRT (HR: 4.39; 95% confidence interval [1.05, 18.43]; P = 0.04) found an independent predictors of ischemic strokes and transient ischemic attacks during follow‐up .…”

“…Two plausible reasons for increased ischemic events after LAAc are reduction in the intensity of postimplant antithrombotic therapy and thrombogenicity of the intraatrial foreign device . Furthermore, little is known about the physiological consequences of LAAc.…”

“…An incomplete closure of the device, which would require the prolongation of OAC, would be a relevant issue in patients submitted to LAAc with a real contraindication to long‐term OAC . Despite all, the DRT after LAAc is not frequent (3.7‐7.2%) but is associated with a higher rate of stroke and systemic embolism . Among those known to have DRT, the adjusted risk for stroke or systemic embolism was more than tripled compared with the risk without DRT .…”