Incomplete LAA closure after Watchman implantation can lead to thrombus formation, which may be successfully managed with temporary anticoagulation followed by a second closure device.
Supports short-term anticoagulation plus re-closure for post-Watchman thrombus; hypothesis-generating pending controlled data.
We report a case of incomplete left atrial appendage (LAA) closure after Watchman device (Atritech, Boston Scientific, Natrick, MA) implantation which subsequently developed a thrombus 3 years after the initial procedure. The thrombus resolved after a short period of anticoagulation with warfarin, and the LAA was successfully occluded with a second-generation Amplatzer Cardiac Plug (Amulet device, AGA, St Jude Medical, Minneapolis, MN). Incomplete LAA closure may be associated with increased risk of thrombus formation and further closure with a second device after a course of anticoagulation may be a reasonable and feasible strategy.
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Lam et al. (2014) studied this question.
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