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The LAA OD has been shown to be non-inferior to anticoagulation (AC) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and has a safe and effective profile with low ischemic stroke risk per Protect AF and EWOLUTION trials.
A 72-year-old male with non-ischemic cardiomyopathy Ejection Fraction of 30-35% status-post CRT-D, 10-year history of NVAF (CHA2DS2-VASc 5, HAS-BLED 4), and multiple strokes presented for LAA OD implant. Apixaban was taken the night before. Intra-procedural transesophageal echocardiogram (TEE) showed no visible thrombus. Prior to crossing the atrial septum, 5,000 units of heparin was given; INR was 1.5. Within 3 minutes of partial deployment of the OD, a thrombus developed to a size of 3.2cm x1.8 cm, seen on live TEE.
As thrombus developed on the guidewire and OD, both were quickly retrieved into the sheath, and removed completely. Treatment with thrombolytics or GPIIbIIIa inhibitors was forgone given the risk for bleeding. Procedure was aborted and TEE showed no residual thrombus in the LAA or left atrium. The patient did not sustain neurovascular complications through time of discharge.
This case highlights the challenge in management of acute intra-procedural thrombus formation and continued need for further research about optimal AC with LAA OD implantation.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: FIT Clinical Decision Making: Interventional Cardiology, Ischemic Heart Disease and Vascular Medicine
Abstract Category: Interventional Cardiology
Presentation Number: 1108-205
- 2018 American College of Cardiology Foundation