Closure Device-Related Thrombosis After Anticoagulation With Dabigatran in Patients Undergoing Percutaneous Left Atrial Appendage Closure: Case Reports and Literature Review

Figures

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  Figure 1. Flow chart of the care process for the presented cases. LAAO, left atrial appendage occlusion; TEE, transesophageal echocardiogram; DRT, device-related thrombosis; dual antiplatelet, 100 mg of aspirin combined with 75 mg of clopidogrel; mono antiplatelet, 100 mg of aspirin only.

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  Figure 2. Left atrial appendage occlusion-related thrombus anticoagulated with dabigatran. (a) TEE 2-dimensional view displayed thrombosis (2.59 cm × 1.67 cm) on the surface of the occluder (a1). After six weeks of warfarin treatment, a regression of the thrombosis was shown (1.27 cm × 0.605 cm), which confirmed the diagnosis of device-related thrombosis (a2). (b) TEE revealed a thrombus (0.713 cm × 0.621 cm) on the anterolateral surface of the occluder (b1) and the total disappearance of the thrombus after initiation of anticoagulation therapy with rivaroxaban (b2). (c) TEE check-up revealed abnormal hemodynamics in the LAA, identified as thrombosis (0.713 cm × 0.621 cm) (c1), and total elimination of DRT after 3 months following anticoagulation treatment with warfarin (c2). (d) TEE revealed a thrombus (0.661 cm×0.227 cm) on the surface of the occluder (d1) and the total disappearance of the thrombus after the initiation of anticoagulation therapy with warfarin (d2). Red arrows indicate the thrombosis.