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April 26, 2011Catheterization and Cardiovascular InterventionsOpen Access

Thrombus formation after left atrial appendage exclusion using an amplatzer cardiac plug device

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Key result

A 66-year-old man developed a thrombus on an Amplatzer cardiac plug device 3 months post-implantation after stopping clopidogrel, which completely resolved after 2 months of enoxaparin therapy.

Population

1 patient with permanent atrial fibrillation, previous stroke, and contraindication for long-term oral…

Design

Case_report

Follow-up

5 months

Authors

ICIgnacio Cruz‐GonzálezInterventional / Structural CardiologyJMJavier Martín MoreirasInterventional / Structural CardiologyEGEulogio Garcı́aInterventional Cardiology

Discussion

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Implication

May signal thrombus risk after early clopidogrel stop post-Amplatzer implantation; leaves open optimal antithrombotic duration.

Key Points

  • To report a case of device-associated thrombus formation following left atrial appendage exclusion with an Amplatzer cardiac plug and describe its successful medical management.
  • Assessed a 66-year-old male with permanent atrial fibrillation and prior stroke who underwent percutaneous left atrial appendage closure using a 22-mm Amplatzer cardiac plug.
  • Monitored clinical and imaging outcomes via transesophageal echocardiography after antiplatelet therapy discontinuation due to lower gastrointestinal bleeding.
  • Transthoracic and transesophageal echocardiography at 3 months confirmed successful left atrial appendage exclusion but detected a thrombus on the atrial surface of the device following clopidogrel interruption.
  • Medical therapy consisting of acetylsalicylic acid 100 mg daily and enoxaparin 60 mg twice daily resulted in complete thrombus resolution after 2 months of treatment.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
1 patient (66-year-old man) with permanent atrial fibrillation, previous stroke, and contraindication for long-term oral anticoagulant therapy
I
Intervention
Left atrial appendage closure with a 22-mm Amplatzer cardiac plug device, initially followed by acetyl salicylic acid 100 mg and clopidogrel 75 mg daily (clopidogrel stopped at 4 weeks), then treated with enoxaparin 60 mg bid
O
Outcome
Thrombus formation on the device surfacesafety

This case demonstrates that thrombus formation can occur on the Amplatzer cardiac plug device following early cessation of dual antiplatelet therapy, but can be successfully resolved with enoxaparin.

Cite This Study

Cruz‐González et al. (2011) conducted a case report in Permanent atrial fibrillation (n=1). Amplatzer cardiac plug device was evaluated on Thrombus formation on the atrial surface of the device. A 66-year-old man developed a thrombus on an Amplatzer cardiac plug device 3 months post-implantation after stopping clopidogrel, which completely resolved after 2 months of enoxaparin therapy.

synapsesocial.com/papers/6a125cc645487b7639a65618https://doi.org/10.1002/ccd.23126

Topics

Left atrial appendage closureAtrial fibrillationPersistent AF managementAnticoagulation in AFDual antiplatelet therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Transcatheter occlusion of the left atrial appendage for stroke prevention2005 · 28 citations
  2. 2Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation2002 · 435 citations
  3. 3Thrombus formation on transcatheter ASD occluder device in a patient with coagulation factor XII deficiency1998 · 23 citations
  4. 4Surgical removal of atrial septal defect occlusion system-devices1997 · 44 citations
  5. 5Left atrial appendage closure with amplatzer cardiac plug in atrial fibrillation: Initial european experience2010 · 424 citations