TCT-727 Canadian Multi-Center Experience with WATCHMAN for Percutaneous Left Atrial Appendage Closure

Saw, Jacqueline; Fahmy, Peter; Azzalini, Lorenzo; Marquis, Jean-François; Hibbert, Benjamin; Morillo, Carlos; Carrizo, Aldo; Ibrahim, Réda

doi:10.1016/j.jacc.2015.08.748

Cited by 2 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This approach appears to be successful in the majority of patients, especially in those with small thrombus. As reported by Kubo et al and Saw et al, the thrombus disappeared in all patients at follow-up TEE examination, mostly within 6 months after the identification of device-associated thrombus [9,10]. 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].…”

Section: Case Reportmentioning

confidence: 57%

“…In the study by Kubo et al there were no death, stroke and systemic embolism events during a follow-up of 1456 ± 546 days [9]. In the Canadian multi-center registry, there was only 1 case of transient ischemic attack and no stroke or death during a mean follow-up of 173.8 ± 117.3 days [10]. Unexpectedly, the patient discussed in this case report remained completely asymptomatic despite the presence of large, mobile thrombus in the LA.…”

Section: Case Reportmentioning

confidence: 93%

“…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%

“…In the majority of studies, warfarin therapy was restarted or continued for another 4-8 weeks after detection of device-related thrombus [5,9,10]. In some cases, low-molecular-heparin treatment may be also considered for another 4-8 weeks [5].…”

Section: Case Reportmentioning

confidence: 99%

“…There is only little evidence on the association between the presence of device-attached thrombus and an increased incidence of thromboembolic events [2,9,10]. Acute stroke caused by air or thrombus embolization after implantation of the WD occurred in 1.1% of 478 procedures in the PROTECT AF trial during a mean follow-up of just more than a year [2].…”

Section: Case Reportmentioning

confidence: 99%

See 4 more Smart Citations

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

Świątkiewicz

Woźnicki²,

Sukiennik³

et al. 2016

Medical Research Journal

View full text Add to dashboard Cite

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.

show abstract

Section: Case Reportmentioning

confidence: 57%

Section: Case Reportmentioning

confidence: 93%