Thrombus after transcatheter closure of ASD with an Amplatzer septal occluder assessed by three dimensional echocardiographic reconstruction

Acar, Philippe; Aggoun, Yacine; Abdel-Massih, Tony

doi:10.1136/heart.88.1.52-a

Cited by 24 publications

(17 citation statements)

References 8 publications

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“…If more than 6 months is necessary for complete neoendocardial coverage of both the right and left atrial discs, the risk of thrombus formation persists after the standard 6 months of antiplatelet therapy has been concluded. Different authors have reported cases of thrombus formation on the device more the 6 months after ASD transcatheter closure [4,5]. The question is, how long must antiplatelet therapy last after transcatheter ASD closure.…”

mentioning

confidence: 99%

Endothelialization of ASD devices for transcatheter closure: possibility or reality?

Chessa

Butera

Frigiola

et al. 2004

International Journal of Cardiology

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mentioning

confidence: 99%

Endothelialization of ASD devices for transcatheter closure: possibility or reality?

Chessa

Butera

Frigiola

et al. 2004

International Journal of Cardiology

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“…This complicated, firstgeneration device has been abandoned with the increased availability of new generation, self-centering occluder systems that allow a user-friendly and easy implantation. However, device thrombosis has been reported with virtually any available occluder system including not only the ASDOS device [19,25,26,27], but also CardioSEAL/Starflex [14,17,28,29], Angle Wings [15,17], buttoned device [8], Clamshell [10], Helex [17], PFO-Star/CardiaStar [11,12,17,30] and Amplatzer device [17,22,30,31]. Most of these studies represent case reports and no randomized study has been published.…”

Section: Thrombus Formation: Detection and Risk Factorsmentioning

confidence: 97%

“…Once device thrombosis has occurred, medical treatment options include systemic anticoagulation therapy with heparin [22,31] or warfarin [14], the use of GP IIa/IIIb antagonists in conjunction with thrombolytic [29] or heparin therapy [32]. Again, there are no randomized reports available to assess the effectiveness of any of these treatment strategies against the others.…”

Section: Thrombus Formation: Detection and Risk Factorsmentioning

confidence: 98%

The Role of Antiplatelet Agents in the Management of Patients Receiving Intracardiac Closure Devices

Franke¹,

Kühl

2006

CPD

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Transcatheter closure of septal defects has become a widely used alternative to surgery or life-long anticoagulant therapy especially in patients with atrial septal defects (ASD) and patent foramen ovale (PFO). Post-procedural complications include thrombus formation on the occluder in about 0-10% of all cases. Therefore antithrombotic prophylaxis after device implantation is believed to be necessary, but still is variable and remains controversial. To date no randomized studies have been published to assess the optimal anticoagulation strategy. Thus, therapy is based on empirical data, local experience and case reports from the literature. The present review tries to give an overview on most of these mainly retrospective single center studies and summarizes their results. Factors influencing the rate of thrombus formation may be device type, existence of thrombophilic disorders and prophylactic medication. Thrombus formation has been described for each of the existing occluder types without a significant difference between the devices. For antithrombotic prophylaxis, most centers at present use either acetyl salicylic acid alone (ASA; 81 to 325 mg) for 6 months or a combination of ASA and clopidogrel (75 mg) for 6 to 8 weeks followed by ASA for additional 4 to 8 months. Inherited thrombophilic disorders should be excluded before device implantation in order to adapt antithrombotic prophylaxis. Follow-up examinations after device implantation should be performed using TEE within the first 4 weeks after implantation. Thus, thrombi may be recognized early enough to extend the antithrombotic regimen in order to avoid surgical device explantation.

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“…Thrombus developed on eight different types of transcatheter devices. All commercially available devices had at least one reported case of thrombosis: PFO-Star (17 patients) [4,5,8,15], ASDOS (13 patients) [5,7,[13][14][15], CardioSEAL Starflex (9 patients) [5,12,18,20], CardioSEAL (5 patients) [5,9,16,17,19], Angel Wings (4 patients) [5,17], Amplatzer (4 patients) [5,6,10,15], Buttoned (1 patient) [11], and Helex (1 patient) [5]. Patient age was available in half of the cases (mean age, 44.2 Ϯ 9.8 years).…”

Section: Thrombus Informationmentioning

confidence: 99%

Thrombosis after septal closure device placement: A review of the current literature

Sherman

Hagler

Cetta

2004

Cathet Cardio Intervent

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Thrombus formation has been described for all types of commercially available transcatheter septal occlusion devices. Most reports have been single-institution case studies. Screening for hypercoagulable conditions prior to device placement and anticoagulation after device deployment has been variable. The objective of this study was to synthesize the current experience with device thrombosis; the Medline database from 1980 until 2004 was searched. Seventeen articles identified 54 unique patients with device thrombosis. Thrombus developed on eight different types of transcatheter devices. All commercially available devices had at least one reported case of thrombosis. Patient mean age was 44.2 +/- 9.8 years. Thrombosis was diagnosed at a mean of 5 months after device deployment. Prior to device placement, 12 patients had normal coagulation evaluations and 5 had coagulopathies. For 37 patients, no mention was made in the report of coagulation studies. Prior to device thrombosis, 26 patients received aspirin and clopidogrel, 15 patients received aspirin alone, 8 received warfarin, 2 heparin alone, 1 aspirin and warfarin. One patient with hemophilia A received no anticoagulation and in one case treatment prior to thrombosis was not reported. After device thrombosis, 35 patients were treated with warfarin with thrombus resolution, 2 had successful lytic therapy, 1 was treated with heparin alone. Sixteen patients had surgical explantation of the device. Septal occlusion device thrombosis is rare. All types of commercially available devices have been associated with thrombosis. All patients should have early (< or = 3 months) echocardiographic surveillance for device thrombosis. Thorough coagulation evaluation is imperative prior to transcatheter device placement.

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Thrombus after transcatheter closure of ASD with an Amplatzer septal occluder assessed by three dimensional echocardiographic reconstruction

Cited by 24 publications

References 8 publications

Endothelialization of ASD devices for transcatheter closure: possibility or reality?

Endothelialization of ASD devices for transcatheter closure: possibility or reality?

The Role of Antiplatelet Agents in the Management of Patients Receiving Intracardiac Closure Devices

Thrombosis after septal closure device placement: A review of the current literature

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