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WATCHMAN device-related thrombus successfully treated with apixaban: A case report.

ABSTRACT:

Rationale

Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus.

Patient concerns

A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He was prescribed dual anti-platelet therapy with aspirin and clopidogrel.

Diagnosis

Reassessment echocardiography 3 months later found device-related thrombus.

Interventions

The antithrombotic regimen was switched from dual antiplatelet therapy to apixaban.

Outcomes

Reassessment echocardiography 3 months later revealed complete resolution of the device-related thrombus. Apixaban was stopped. He had dual antiplatelet therapy for 6 more months followed by life-long aspirin. There was no bleeding complication since implantation of Watchman device.

Lessons

We demonstrated successful treatment of device-related thrombus with a short course of apixaban with complete resolution of thrombus. Further randomized controlled trials are required to determine the choice and duration of drug therapy for device-related thrombus.

SUBMITTER: Wong CK

PROVIDER: S-EPMC5708950 | biostudies-literature |

REPOSITORIES: biostudies-literature

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