Key result
A 79-year-old man developed a 21 mm × 18 mm device-related thrombus 10 years after WATCHMAN implantation, which markedly diminished after 111 days of apixaban therapy.
Case Report (n=1)
Device-related thrombus on a WATCHMAN device can occur as late as 10 years post-implantation and may be successfully treated with apixaban.
Very late device-related thrombus possible after WATCHMAN; leaves open optimal long-term anticoagulation and surveillance protocols.
Left atrial appendage closure with the WATCHMAN device is an alternative to chronic oral anticoagulation for thromboembolic prophylaxis in atrial fibrillation patients. Left atrial device-related thrombus (DRT) has been described in the first year after implant with an incidence of ~6%. A 79-year-old man underwent WATCHMAN device placement in 2006. Routine protocol specified follow-up transesophageal echocardiograms (TEE) at 6 weeks, 6 months, and 1 year following implant showed no evidence for DRT or peri-device flow. A decade after device implant, the patient presented with severe symptomatic aortic stenosis and underwent repeat TEE, which revealed a 21 mm × 18 mm DRT on the LA aspect of the WATCHMAN device. He was prescribed apixaban 5 mg po BID. A TEE performed 111 days later demonstrated marked diminution in the DRT (9 mm in diameter). This case demonstrates that WATCHMAN DRT may occur late following implantation.
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Shamim et al. (2016) conducted a case report in Atrial fibrillation with WATCHMAN device implant (n=1). WATCHMAN device was evaluated on Device-related thrombus (DRT). A 79-year-old man developed a 21 mm × 18 mm device-related thrombus 10 years after WATCHMAN implantation, which markedly diminished after 111 days of apixaban therapy.
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