Incidence, Characterization, and Clinical Impact of Device-Related Thrombus Following Left Atrial Appendage Occlusion in the Prospective Global AMPLATZER Amulet Observational Study

Aminian, Adel; Schmidt, Boris; Mazzone, Patrizio; Berti, Sérgio; Fischer, Sven; Montorfano, Matteo; Lam, Simon S. K.; Lund, Juha; Asch, Federico M.; Gage, Ryan; Cruz-González, Ignacio; Omran, Heyder; Tarantini, Giuseppe; Nielsen‐Kudsk, Jens Erik

doi:10.1016/j.jcin.2019.02.003

Cited by 73 publications

(49 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2019, Aminian reported the results of a global observational study on the occurrence of DRT after Amulet occluder implantation. In 1078 patients with AF implanted with the Amulet device, 17 patients had DRT by the 1‐year follow‐up, with an annual rate of 1.7%, and one patient had recurrent DRT 9 . In 2017, Lempereur et al summarized 30 studies including 1 randomized controlled trial and 29 multi‐center registration studies, single‐center reviews, or case reports.…”

Section: Incidence Of Drt In Real‐world Clinical Practicementioning

confidence: 99%

“…The criteria included an echo density on the LA aspect of the device: (a) not explained by imaging artifacts; (b) inconsistent with normal healing/device incorporation; (c) visible in multiple TEE planes, (d) in contact with the WATCHMAN device; and (e) exhibiting independent motion 25 . The criteria of DRT in the Prospective Global AMPLATZER Amulet Observational Study were defined as an echocardiographic or computed tomography (CT) density on the LA aspect of the device: (a) not explained by imaging artifact; (b) inconsistent with normal healing; (c) visible in multiple TEE or CT planes; and (d) in contact with the device 9 . Saw et al reported their preliminary experience of using CT as an alternative to TEE for post‐procedural surveillance with the ACP device.…”

Section: Diagnosis Of Drtmentioning

confidence: 99%

“…However, as with most invasive procedures, LAAC can cause low event rate of serval procedural complications including pericardial effusions with or without tamponade, air embolism with subsequent stroke, and device‐related thrombus (DRT). Recently, DRT after LAAC has been described in a number of different devices, 8–10 which is associated with increased risk of stroke. In this article, the incidence, risk factors, time course, and management of DRT were reviewed and discussed based on currently available evidence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Device related thrombus after left atrial appendage closure: State of the art

Bai

Jiang

2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Patients with AF are at higher risk of stroke with the left atrial appendage (LAA) being the most common site for thrombus formation. Although oral anticoagulation (OAC) remains the standard of care for stroke prevention in AF patients, there are still several limitations, including increased risk of bleeding and noncompliance. LAA closure (LAAC) has been found to be non‐inferior to OAC in preventing all‐cause strokes and systemic embolisms in randomized clinical trials, and is increasingly performed for stroke prevention in patients with nonvalvular AF (NVAF). However, device‐related thrombus (DRT) after LAAC and a potentially increased risk of stroke related to DRT were observed in several registered studies, and attract wide concern. This review provides a comprehensive update on the incidence, mechanism, risk factors, prevention, diagnosis, and treatment of DRT after LAAC in patients with NVAF.

show abstract

Section: Incidence Of Drt In Real‐world Clinical Practicementioning

confidence: 99%

Section: Diagnosis Of Drtmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Device related thrombus after left atrial appendage closure: State of the art

Bai

Jiang

2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Few studies have investigated the ability of DOACs to prevent thrombosis in patients with implanted devices. The RE-ALIGN study compared dabigatran to warfarin in patients with mechanical heart valve prostheses, but the study was prematurely stopped due to excess of bleeding and thrombotic events [8]. More recently, the GALILEO trial of rivaroxaban after transcatheter aortic valve insertion was stopped early due to patient harm [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, the GALILEO trial of rivaroxaban after transcatheter aortic valve insertion was stopped early due to patient harm [9,10]. It has been hypothesized that foreign artificial materials implanted in the heart, such as valve prostheses and possibly also occluder devices, may trigger the tissue pathway of coagulation on the artificial surface, a pathway that is unaffected by DOACs [8]. Such a mechanism could potentially lead to device thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Direct Oral Anticoagulants After Percutaneous Patent Foramen Ovale (PFO) Closure: A Call for Caution

et al. 2020

Self Cite

View full text Add to dashboard Cite

Vase have nothing to disclose. Prof. Jens Erik Nielsen-Kudsk has been a consultant for Gore Medical and a Proctor and Investigator for Boston Scientific and Abbott. Erik Lerkevang Grove has no conflicts related to this manuscript, but reports the following general COIs: He has received speaker honoraria or consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, MSD, MundiPharma, Portola Pharmaceuticals, and Roche. He is an investigator in the SATELLITE and FLAVOUR studies (AstraZeneca) and has received minor unrestricted research grants from Boehringer Ingelheim

show abstract

In-silico Analysis of Device-Related Thrombosis for Different Left Atrial Appendage Occluder Settings

Planas

Mill

Olivares

et al. 2022

Lecture Notes in Computer Science

View full text Add to dashboard Cite

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and is associated to an increasing risk of stroke. Most AFrelated strokes are formed in the left atrial appendage (LAA). To prevent thrombus formation, LAA occlusion (LAAO) is considered a suitable alternative for AF patients with contraindications for anti-coagulation treatment. Nevertheless, LAAO is linked to a non-negligible risk of generating thrombus at the surface near the device (i.e., device-related thrombus, DRT), depending on the implantation settings. For instance, it has been shown that not covering the pulmonary ridge (PR) with the LAAO increases the risk of DRT. In-silico analysis is a useful tool to better understand the blood flow patterns after LAAO and predict the risk of DRT for a given patient and device configuration. In the present work we designed a modelling pipeline based on fluid simulations, including a thrombus model using discrete phase modelling, to analyse the risk of DRT in six patient-specific geometries for different LAAO settings. In particular, we studied the possible incidence of DRT depending on the device positioning (covering/uncovering the PR) and type (Amplatzer Amulet and Watchman FLX). The resulting in-silico indices demonstrated that covering the PR entails less thrombogenic patterns than uncovering it. In our study, disk-based devices had better adaptability to complex LAA morphologies and a slightly minor associated risk of DRT than non-disk devices.

show abstract

Incidence, Characterization, and Clinical Impact of Device-Related Thrombus Following Left Atrial Appendage Occlusion in the Prospective Global AMPLATZER Amulet Observational Study

Cited by 73 publications

References 20 publications

Device related thrombus after left atrial appendage closure: State of the art

Device related thrombus after left atrial appendage closure: State of the art

Direct Oral Anticoagulants After Percutaneous Patent Foramen Ovale (PFO) Closure: A Call for Caution

In-silico Analysis of Device-Related Thrombosis for Different Left Atrial Appendage Occluder Settings

Contact Info

Product

Resources

About