Author + information
- Received August 12, 2016
- Revision received September 6, 2016
- Accepted September 8, 2016
- Published online December 19, 2016.
- Juan Caro-Codón, MD∗ (, )
- Guillermo Galeote, MD,
- Carlos Álvarez-Ortega, MD,
- Raul Moreno, MD, PhD and
- Jose-Luis López-Sendón, MD, PhD
- ↵∗Reprint requests and correspondence:
Dr. Juan Caro-Codón, Cardiology Department, La Paz University Hospital, C/Lucio del Valle 12, 5° mdcha. PC: Madrid 28003, Spain.
An 83-year-old woman with chronic atrial fibrillation and hypertension underwent left atrial appendage occlusion at another center with a 22-mm Amplatzer cardiac plug (St. Jude Medical, Minneapolis, Minnesota) after embolic central retinal artery occlusion while receiving treatment with dabigatran. Dual antiplatelet therapy with aspirin and clopidogrel was initiated, but both drugs were stopped after 3 months of follow-up with transthoracic echocardiography. Two years later, she was admitted to our hospital with acute cholecystitis. A computed tomography scan requested during admission to rule out pulmonary embolus showed a large filling defect in the left atrium, next to the left atrial appendage occluder, which was suggestive of atrial thrombus (Figure 1A). Subsequent transesophageal echocardiography confirmed the presence of a giant ball-shaped thrombus on the atrial aspect of the occluder disc (Figures 1B and 1C, Online Videos 1 and 2). The patient was discharged against medical advice. On follow-up, she experienced a second episode of embolic central retinal artery occlusion despite treatment with low-molecular-weight heparin.
Device-related thrombus after percutaneous left atrial appendage closure occurs in a significant proportion of patients in real-life registries (1). Evidence regarding post-procedural antithrombotic management is lacking, but dual antiplatelet therapy is usually used after Amplatzer cardiac plug implantation, followed by single antiplatelet treatment. This case illustrates that even in patients without known risk factors for device-related thrombus (2), changes in the antithrombotic regimen should be guided by follow-up transesophageal echocardiography. It also confirms the useful role of computed tomography scan as a noninvasive technique for device surveillance (3).
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 12, 2016.
- Revision received September 6, 2016.
- Accepted September 8, 2016.
- American College of Cardiology Foundation
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