Project description:Most physicians regard left atrial appendage (LAA) thrombus as a contraindication for LAA occlusion due to risk of distal embolization which is a serious complication. Here we report a case of successfully implanted Amplazter cardiac plug without complication in elderly patients having LAA thrombus with recurrent embolic events despite oral anticoagulants for prevention of thromboembolic events. <Learning objective: LAA thrombus is not completely resolved in all cases and can be a potential source of stroke or embolization even during anti-coagulation. We would like to share a case that suffered from 6 strokes or embolizations despite anti-coagulation, warfarin or non-vitamin K antagonist oral anti-coagulants due to incomplete resolution of LAA thrombus. In this clinical situation, we can suggest LAA occlusion to isolate thrombus from LA and prevent further stroke or embolization.>.

| S-EPMC6149266 | biostudies-literature

Epicardial fat mimicking left atrial appendage thrombus.

Project description: Not available

| S-EPMC8084376 | biostudies-literature

Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure

Project description: Not available

| S-EPMC10956221 | biostudies-literature

Left atrial appendage thrombus on full-dose dabigatran treatment: a case report.

Project description:BackgroundDabigatran is a direct competitive thrombin inhibitor approved for stroke prevention in non-valvular atrial fibrillation. At full-dose, dabigatran showed similar rates of bleedings and higher efficacy compared to warfarin.Case summaryWe report a case of acute ischaemic stroke in a patient treated with dabigatran 150 mg b.i.d. for atrial fibrillation. After an off-label treatment with idarucizumab, a humanized monoclonal antibody approved for dabigatran reversal, we performed a successful intravenous thrombolysis (IVT). Transoesophageal echocardiography showed a left atrial appendage (LAA) thrombus, despite full-dose dabigatran and an adequate therapy adherence.DiscussionThere are few cases of LAA thrombus during dabigatran treatment reported in literature till date. We analyse the possible pathogenetic mechanisms involved in dabigatran failure, including drug interactions and unexpected genetic variations interfering with dabigatran serum levels suggesting periodical assessment of direct Oral Anticoagulant levels. Furthermore, we confirm initial reports of safety and efficacy of intravenous thrombolysis after idarucizumab, in case of dabigatran failure.

| S-EPMC7319812 | biostudies-literature

A deadly mix - rheumatic mitral stenosis, preexcited atrial fibrillation, left atrial appendage thrombus and left atrial appendage accessory pathway.

Project description: Not available

| S-EPMC5784605 | biostudies-literature

Percutaneous left atrial appendage closure using the LAmbre device in patients with atrial fibrillation and left atrial appendage thrombus

Project description:Background Left atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device. Materials and methods A total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients’ clinical events were evaluated during the perioperative and follow-up periods. Results The median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53–73], 3 [2–4], and 2 [2–3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325–865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients. Conclusion LAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.

| S-EPMC9729287 | biostudies-literature

Late left atrial appendage closure device displacement and massive thrombus formation: a case report.

Project description:BackgroundLeft atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation therapy for the prevention of stroke in selected patients with atrial fibrillation (AF). Infrequently, left atrial (LA) device-related thrombus formation occurs and it is poorly understood. Thrombus formation due to incomplete covering of the LAA is even rarer and may occur within the first few months after device implantation.Case summaryHere, we present a case of a 68-year-old male patient with permanent AF, drug- and hepatitis induced liver cirrhosis (CILD Score B), and prior aortic valve replacement. The patient had a history of percutaneous LAA closure using a WATCHMAN device. He developed massive peri-device leak and thrombus arising from the space between the device and appendage cleft 2 years after implantation. Because of the high bleeding risk with a HAS-BLED score of 5 points, surgery was chosen as the therapy of choice instead of long-term anticoagulation. The patient was discharged in good clinical condition and has been scheduled for a yearly follow-up.DiscussionThis case emphasizes the importance of choosing appropriately sized LAA occluder devices and planning for regular post-interventional follow-ups to minimize the risk of per-device leaks and thrombi.

| S-EPMC7180543 | biostudies-literature

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