Abstract
Left atrial appendage occlusion devices are an alternative to oral anticoagulation
in patients with nonvalvular atrial fibrillation who are at risk of ischemic stroke.
Thromboprophylaxis after implantation is recommended, but the optimal regimen is unknown.
We report a clinicopathologic case in which thrombus adherent to an incompletely endothelialized
WATCHMAN device (Boston Scientific, Marlborough, MA) resulted in multiple thromboembolic
events, contributing to a fatal outcome. This case illustrates uncertainties regarding
the device's endothelialization process.
Résumé
Les dispositifs d’occlusion de l’appendice auriculaire gauche sont une alternative
à l’anticoagulation par voie orale chez les patients atteints de fibrillation auriculaire
non valvulaire qui sont exposés au risque d’accident vasculaire cérébral ischémique.
On recommande la thromboprophylaxie après l’implantation, mais on ignore le schéma
posologique optimal. Nous décrivons les caractéristiques clinicopathologiques d’un
cas chez qui le thrombus adhérent au dispositif WATCHMAN non totalement endothélialisé
(Boston Scientific, Marlborough, MA) a entraîné de multiples événements thrombo-emboliques
qui ont contribué à l’issue fatale. Ce cas met en lumière les incertitudes concernant
le processus d’endothélialisation du dispositif.
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References
- Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: The ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology).J Am Coll Cardiol. 2013; 61: 2551-2556
- Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry.Circulation. 2011; 123: 417-424
- Early Canadian multicenter experience with WATCHMAN for percutaneous left atrial appendage closure.J Cardiovasc Electrophysiol. 2017; 28: 396-401
Article info
Publication history
Published online: December 26, 2017
Accepted:
December 11,
2017
Received:
November 22,
2017
Footnotes
See page 342.e15 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
