Key result
Complex post-LAAO antithrombotic management avoids rifampin interactions and addresses subsequent device leaks.
Why the study?
Temporary postimplantation antithrombotic therapy is recommended following left atrial appendage occlusion, but management can present significant challenges in complex patients.
Case Report (n=1)
This case report highlights the challenges of managing antithrombotic therapy after LAAO device placement in patients with complex drug interactions and device leaks.
Alerts clinicians to antithrombotic pitfalls with rifampin post-LAAO and leaks; leaves open optimal regimens pending prospective data.
Antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF) has dramatically shifted from warfarin, a vitamin K antagonist, to the direct oral anticoagulants (DOACs) such as dabigatran, apixaban, and rivaroxaban. In patients with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) devices, such as the Watchman™ device, may be considered; however, temporary postimplantation antithrombotic therapy is still a recommended practice. We present a case of complex antithrombotic management, post LAAO device implantation, designed to avoid drug interactions with concomitant rifampin use and remained necessary secondary to subsequent device leak. This case highlights the challenges of antithrombotic therapy post LAAO device placement in a complex, but representative, patient.
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Ahuja et al. (2019) conducted a case report in Atrial fibrillation (n=1). Antithrombotic management was evaluated. Complex antithrombotic management post-LAAO device implantation was required to avoid drug interactions with rifampin and address a subsequent device leak.
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