Key result
LAAO links to late device-related thrombosis at 1 year causing systemic embolism despite heparin therapy.
Why the study?
Device-related thrombosis is a rare but serious complication after left atrial appendage occlusion, and its prediction, detection, and management remain challenging due to a lack of robust evidence-based protocols.
Case Report (n=1)
No
This case highlights the rare but severe risk of late-onset device-related thrombosis and systemic embolism following LAAO, emphasizing the challenges of managing antithrombotic therapy in frail patients.
Late LAAO thrombosis despite anticoagulation signals ongoing risk; leaves open optimal long-term antithrombotic strategies.
Device-related thrombosis (DRT) is a rare but serious complication following left atrial appendage occlusion (LAAO). A 58-year-old woman with permanent atrial fibrillation (AF), multiple comorbidities, and a history of transient ischemic attack despite anticoagulation underwent LAAO in December 2023. Initially prescribed oral anticoagulants, she discontinued them due to side effects and switched to single antiplatelet therapy. Nearly 1-year postprocedure, a thrombus was detected on the LAAO device. Despite heparin infusion, she developed systemic embolism, resulting in splenic infarction and subsequent splenectomy. She was discharged on warfarin, but a persistent thrombus was noted on a 1-month transesophageal echocardiogram, necessitating continued warfarin therapy and serial follow-ups. The prediction, detection, and management of DRT remain challenging and uncertain due to a lack of robust evidence-based protocols. Balancing bleeding and thrombotic risks, especially in frail patients, is complex. While LAAO is an effective stroke prevention strategy for AF patients, the risks of DRT should not be overlooked. Further research is essential to refine DRT management protocols.
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Bordonaro et al. (2025) conducted a case report in Permanent atrial fibrillation (n=1). Left atrial appendage occlusion (LAAO) was evaluated on Device-related thrombosis and systemic embolism. Left atrial appendage occlusion in a 58-year-old woman was complicated by late-onset device-related thrombosis at 1 year, leading to systemic embolism and splenic infarction despite heparin therapy.
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