Key result
Rivaroxaban therapy initiated for post-procedural atrial fibrillation failed to prevent the formation of large thrombi on a newly implanted PFO occluder device after 4 months of follow-up.
Why the study?
Transient AF following percutaneous PFO closure is common, but guidelines lack clear recommendations on the indication or choice of anticoagulant therapy for post-procedural AF.
Case Report (n=1)
No
DOACs like rivaroxaban may be ineffective at preventing device thrombosis on newly implanted PFO occluders, suggesting they should not be routinely used within the first 3 months post-implantation.
Supports caution with DOACs for AF after PFO closure; leaves open optimal regimens for prospective trials.
BACKGROUND Transient atrial fibrillation (AF) following percutaneous patent foramen ovale (PFO) closure is common. Anticoagulation therapy should be considered in selected cases of prolonged AF after PFO closure, but guidelines do not provide clear recommendations on indication or choice of anticoagulant therapy for patients with post-procedural AF. CASE REPORT A 45-year-old woman presented with cryptogenic stroke verified by magnetic resonance imaging (MRI). Echocardiography revealed a PFO, which was closed percutaneously using a Gore septal occluder (25 mm). She was discharged on aspirin monotherapy (75 mg oral daily) according to institutional standard. Three weeks later, she presented with atrial fibrillation (AF). A direct oral anticoagulant (DOAC) (rivaroxaban 20 mg once daily) was initiated and aspirin was discontinued. After 4 months of follow-up, a routine echocardiography revealed large thrombi attached to both sides of the PFO occluder. CONCLUSIONS DOACs may be ineffective in preventing thrombus formation on device surfaces. Until more evidence has been provided, we suggest that DOACs are not routinely used for stroke prevention in patients following PFO closure or similar procedures within the first 3 months after device implantation.
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Bovin et al. (2020) conducted a case report in Intracardiac device thrombosis (n=1). Rivaroxaban was evaluated on Thrombus formation on device surfaces. Rivaroxaban therapy initiated for post-procedural atrial fibrillation failed to prevent the formation of large thrombi on a newly implanted PFO occluder device after 4 months of follow-up.
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