Why the study?
Left atrial appendage closure devices like the WATCHMAN are used when anticoagulation bleeding risks outweigh stroke prevention benefits, but they carry risks including device-related thrombus formation.
Case Report (n=1)
This case highlights the critical importance of adhering to post-procedural antithrombotic guidelines after WATCHMAN implantation to prevent device-related thrombus and embolic stroke.
May support individualized warfarin for massive LAA thrombus in AF with prior GI bleed; leaves open need for prospective trials.
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias encountered. Aggressive and appropriate management, along with identification and modification of risk factors, remains at the forefront of evidence-based practice. Thrombus formation (primarily in the left atrial appendage) and consequent thromboembolism are risks associated with AF. Anticoagulation is utilized to prevent and reduce AF-induced complications such as stroke, heart failure, and death. However, in instances when the risk of bleeding from anticoagulation outweighs the benefits of stroke prevention, other modalities such as left atrial appendage closure (LAAC) devices like the WATCHMAN device (Boston Scientific, MA) are utilized. LAAC devices, such as the WATCHMAN device, are also not without significant risks, one of them being device-related thrombus (DRT) formation. We present a case of device-related thrombus formation post WATCHMAN implantation and a subsequent embolic cerebrovascular accident (CVA).
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Patel et al. (2022) conducted a case report in Atrial fibrillation (n=1). WATCHMAN device implantation was evaluated.
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