The Role of Anticoagulants After Left Atrial Appendage Occlusion.

ABSTRACT:

Background

Left atrial appendage occlusion prevents thromboembolic events in atrial fibrillation patients with bleeding risk, but device-related thrombosis (DRT) remains a challenge.

Case summary

A 78-year-old man with atrial fibrillation (CHA₂DS₂-VASc score = 3) and prior intracranial hemorrhage underwent successful left atrial appendage occlusion with a 22-mm Amplatzer Amulet. After stepping down from apixaban to aspirin, DRT developed. Thrombi resolved with apixaban but recurred on its discontinuation. A multiscale model integrating hemodynamics, thrombus formation events, and apixaban revealed fibrin buildup beneath the pulmonary ridge, matching clinical thrombus. Optimized placement alone prevented fibrin formation in the virtual model.

Discussi

SUBMITTER: Segarra-Queralt M 

PROVIDER: S-EPMC12861666 | biostudies-literature | 2025 Dec

REPOSITORIES: biostudies-literature