Abstract 14098: Early Recurrence Following Resolution of a Watchman Device Related Thrombus

Abstract

Introduction: Left atrial appendage occlusion devices are widely used as stroke prevention alternative to oral anticoagulation in patients with atrial fibrillation (AF). Recently, there has been growing concern for device related thrombus (DRT) and the associated risk for stroke and systemic embolism. Studies have mentioned the incidence, predictors, and risk factors for DRT post left atrial appendage occlusion devices. However, not much is known about DRT recurrence, and reports describing such events despite anticoagulation are very limited. Methods: This report describes early DRT recurrence post WATCHMAN implantation following initial treatment to resolution of DRT with anticoagulation. Results: A 79-year-old woman with permanent atrial fibrillation and no identifiable risk factors for DRT, underwent WATCHMAN implantation . TEE at 45 days showed a well-seated WATCHMAN device with no peri-device leak but revealed a DRT on the surface of the device, confirmed by CT angiography. Patient was prescribed Eliquis for 3 months and aspirin 325 mg daily was continued. Complete resolution of DRT was noted on a repeat CT scan 3 months later and Eliquis was discontinued. She returned approximately 1 months later (and few weeks after completing her 3-month course of Eliquis) for a repeat TEE, which now revealed a new recurrent DRT. Conclusions: This report adds to the current literature about early DRT recurrence and possible emphasis on continued anticoagulation following first DRT to prevent recurrence. Although several risk factors have been identified to predict DRT, it is unclear which patients are at increased risk for recurrence of DRT. Patient and procedural factors and the choice of oral anticoagulation seem to play a role. Figure 1: Appearance of device related thrombus on cardiac computed tomography (CT). Illustration of a hypo attenuated thickening on the surface of the left atrial appendage occlusion device suggestive of device related thrombus.