Device-Related Thrombus Overlying a Left-Atrial Occlusion Device Implanted for Persistent Spontaneous Echo Contrast despite Prolonged Oral Anticoagulation Therapy

Elabbassi, Wael; Osman, Ahmed Najeeb; Chowdhury, Mohammed Andaleeb; Nooryani, Arif Al

doi:10.1159/000348319

Cited by 4 publications

(5 citation statements)

References 21 publications

(11 reference statements)

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“…Consistently with a case report by Elabbassi et al describing a 75-year-old woman with device-related thrombus overlying a LA occlusion device implanted in the presence of persistent spontaneous contrast despite prolonged OA, we observed spontaneous contrast in the LA in pre-procedural and follow-up TEE examinations in our patient [13]. In line with the findings of the above studies, it is recommended to perform TEE at 45 days to 6 months after the implantation, since most thrombi were documented so far at 45-day TEE [5].…”

Section: Case Reportsupporting

confidence: 92%

“…Therefore, anticoagulant therapy is recommended in all patients with device-associated thrombus regardless of the symptoms until thrombus resolution is confirmed by follow-up TEE [5]. As reported by Elabbassi et al and observed in our patient, this kind of treatment regimen is not always successful, especially in patients with permanent AF, large LA and dense spontaneous echo contrast in TEE [13].…”

Section: Case Reportsupporting

confidence: 44%

“…inadequate size, incorrect placement or instability of the device) [5,7]. Chronic thrombosis is usually observed in the follow-up TEE examination between 45 days and 3 years after the WD implantation [2,5,[7][8][9][10][11][12][13]. It may be potentially triggered by incomplete closure of the LAA or increased thromboembolic risk in patients, predominantly resulting from the older age and the presence of multiple comorbidities [2,5,7,8].…”

Section: Case Reportmentioning

confidence: 99%

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Device-associated thrombus after percutaneous left atrial appendage closure: a case report and literature review

Świątkiewicz

Woźnicki²,

Sukiennik³

et al. 2016

Medical Research Journal

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Device-associated thrombus after percutaneous left atrial appendage closure: a case report and literature review ABSTRACT Introduction. In the setting of atrial fibrillation (AF), left atrial appendage (LAA) closure using the Watchman TM device (WD) was proven to effectively prevent stroke, systemic embolism and cardiovascular death when compared with warfarin therapy. However, this procedure is potentially associated with the risk of complications, including device-attached thrombus formation.Case presentation. We report a case of a 65-year-old woman with permanent non-valvular AF, a history of ischemic stroke on warfarin treatment, hypertension, diabetes mellitus, heart failure with preserved left ventricular ejection fraction, labile values of the international normalized ratio, enlarged left atrium (LA) and spontaneous echo contrast in echocardiography, who was qualified for percutaneous LAA closure using the WD. The pre-procedural patient assessment indicated high thromboembolic (CHA 2 DS 2 -Vasc Score = 5) and bleeding risk (HAS-BLED Score = 4), and optimal morphology of LAA in transesophageal echocardiography (TEE). After a successful procedure using a 30 mm-sized WD, and despite appropriate antiplatelet and anticoagulation therapy, 6-month follow-up TEE revealed a mobile thrombus (2.4 cm × 0.6 cm) at the atrial side of the WD. Therapy with intravenous heparin was started. However, a control TEE examination after one week revealed progression of the thrombus size (4.2 cm × 0.7 cm) and its protrusion across the mitral valve orifice into the left ventricle. Although the patient remained asymptomatic, cardiosurgical excision of the thrombus was performed due to high risk of thrombus embolization.Conclusions. Late device-associated thrombus formation after implantation of the WD remains a rare but severe complication. Formal recommendations regarding prevention and management of device-related thrombosis are still lacking. In this complex clinical setting, we suggest: 1) careful long-term echocardiographic monitoring after percutaneous LAA closure, especially in patients with permanent AF, high thromboembolic risk, large LA and dense spontaneous echo contrast in echocardiography, and 2) an individualized treatment approach.

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Section: Case Reportsupporting

confidence: 92%

Section: Case Reportsupporting

confidence: 44%

Section: Case Reportmentioning

confidence: 99%

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Device-associated thrombus after percutaneous left atrial appendage closure: a case report and literature review

Świątkiewicz

Woźnicki²,

Sukiennik³

et al. 2016

Medical Research Journal

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“…Prophylactic anticoagulation decreases the risk of a thrombotic event, but it remains elevated until blood viscosity returns to normal [ 1 ]. Thrombus formation, despite adequate oral anticoagulation, was previously described in a patient with persistent spontaneous echo contrast [ 14 ]. Spontaneous echo contrast is the reflection of erythrocyte aggregation, which we described as the consequence of increased blood viscosity [ 15 ].…”

Section: Reviewmentioning

confidence: 99%

COVID-19 Demonstrates That Inflammation Is a Hyperviscous State

Sloop¹,

Pop²,

Weidman³

et al. 2022

Cureus

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Many of the complications of severe coronavirus disease-2019 (COVID-19) are caused by blood hyperviscosity driven by marked hyperfibrinogenemia. This results in a distinctive hyperviscosity syndrome which affects areas of high and low shear. A change in blood viscosity causes a threefold inverse change in blood flow, which increases the risk of thrombosis in both arteries and veins despite prophylactic anticoagulation. Increased blood viscosity decreases perfusion of all tissues, including the lungs, heart, and brain. Decreased perfusion of the lungs causes global ventilation-perfusion mismatch which results in silent hypoxemia and decreased efficacy of positive pressure ventilation in treating pulmonary failure in COVID-19. Increased blood viscosity causes a mismatch in oxygen supply and demand in the heart, resulting in myocarditis and ventricular diastolic dysfunction. Decreased perfusion of the brain causes demyelination because of a sublethal cell injury to oligodendrocytes. Hyperviscosity can cause stasis in capillaries, which can cause endothelial necrosis. This can lead to the rarefaction of capillary beds, which is noted in "long-COVID." The genome of the virus which causes COVID-19, severe acute respiratory syndrome coronavirus 2, contains an extraordinarily high number of the oligonucleotide virulence factor 5'-purine-uridine-uridinepurine-uridine-3', which binds to toll-like receptor 8, hyperactivating innate immunity. This can lead to a marked elevation in fibrinogen levels and an increased prevalence of neutrophil extracellular traps in pulmonary failure, as seen in COVID-19 patients.

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“…Although percutaneous coronary intervention (PCI) with DES has been widely used to treat patients with symptomatic coronary artery disease (CAD) all over the world, recent studies have raised concerns about its long-term clinical safety and efficacy, which remains a challenge for interventional cardiologists, including delayed arterial healing response, in-stent restenosis, late stent thrombosis and the local inflammatory reactions [2,3,4]. Moreover, the systematic pro-inflammatory response after PCI with DES is still poorly defined.…”

Section: Introductionmentioning

confidence: 99%

Drug-Eluting Stent, but Not Bare Metal Stent, Accentuates the Systematic Inflammatory Response in Patients

Liu

Zhuo²,

Liu³

et al. 2014

Cardiology

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Objective: The systematic pro-inflammatory responses after percutaneous coronary intervention with drug-eluting stents (DES) remain poorly defined. Therefore, we compared the systematic pro-inflammatory state of circulating mononuclear cells (MNCs) between DES and bare metal stent (BMS) implantation. Methods: Patients with indications for treatment with stents were randomized in a 1:1 ratio to placement of DES or BMS. The primary endpoint was a change of pro-inflammatory state at 12 weeks post-procedure. Results: Thirty-six consecutive patients received DES or BMS. At 12 weeks after stent implantation, the lipid profile and high-sensitivity C-reactive protein (hs-CRP) improved significantly in both groups. The mRNA levels and plasma concentrations of interleukin-6, tumor necrosis factor-a and matrix metalloproteinase-9 were significantly elevated in the DES group, which was not observed in the BMS group. An increase in NF-γB binding activity and a decrease in PPAR-γ expression in MNCs were observed in the DES group, along with increases in IγB phosphorylation and p50 expression. However, similar changes were not observed in the BMS group. Conclusions: Systematic inflammatory responses were accentuated after the patients were treated percutaneously with DES, despite their improved lipid profile and hs-CRP. These data may provide fundamental information for optimizing therapeutic strategy in the era of DES.

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Device-Related Thrombus Overlying a Left-Atrial Occlusion Device Implanted for Persistent Spontaneous Echo Contrast despite Prolonged Oral Anticoagulation Therapy

Cited by 4 publications

References 21 publications

Device-associated thrombus after percutaneous left atrial appendage closure: a case report and literature review

Device-associated thrombus after percutaneous left atrial appendage closure: a case report and literature review

COVID-19 Demonstrates That Inflammation Is a Hyperviscous State

Drug-Eluting Stent, but Not Bare Metal Stent, Accentuates the Systematic Inflammatory Response in Patients

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