A floating thrombus on a left atrial appendage occluder caused embolic strokes in a patient, resolved with anticoagulation therapy during 18-month follow-up without bleeding complications.
Does apixaban safely resolve left atrial appendage occluder thrombosis in a patient with high bleeding risk?
This case highlights that LAA occluder thrombosis can cause embolic strokes, but can be effectively and safely managed with apixaban even in patients with high baseline bleeding risk.
Absolute Event Rate: 0% vs 0%
Abstract Background Left atrial appendage occlusion is an alternative for stroke prevention in atrial fibrillation (AF) patients who are unsuitable for long-term oral anticoagulation due to bleeding risks. While intended to reduce hemorrhagic stroke, left atrial appendage occluder devices can rarely lead to thrombus formation and subsequent embolic events. Case Summary A 75-year-old woman with paroxysmal AF and cerebral amyloid angiopathy had an LAA occluder implanted due to concerns for high bleeding risk. She presented with mild left leg weakness; magnetic resonance imaging revealed embolic strokes in the left cerebellum and right cerebral hemisphere. Importantly, transesophageal echocardiography identified a floating thrombus on the LAA occluder as cause of embolic strokes. Given the high risk of bleeding, an interdisciplinary decision was made collaboratively with the patient to initiate anticoagulation therapy with apixaban. A rigorous follow-up protocol was established to monitor her condition. During an 18-month follow-up imaging showed effective thrombus resolution without bleeding complications. Discussion Our case report underscores the need for vigilant monitoring after LAA occluder implantation and reconsideration of anticoagulation therapy, even in patients with high bleeding risks. The findings emphasize the limitations of LAA occlusion alone and the necessity for improved device design and management strategies to enhance patient safety.
Riedemann et al. (Wed,) reported a other. A floating thrombus on a left atrial appendage occluder caused embolic strokes in a patient, resolved with anticoagulation therapy during 18-month follow-up without bleeding complications.