Device-associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet.

Lempereur, Mathieu;Aminian, Adel;Freixa, Xavier;Gafoor, Sameer;Saw, Jacqueline;et.al.
(2017) Catheterization and Cardiovascular Interventions — Vol. 90, n° 5, p. E111-E121 (2017)

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Authors
  • Lempereur, Mathieu
    Author
  • Aminian, Adel
    Author
  • Freixa, Xavier
    Author
  • Gafoor, Sameer
    Author
  • Kefer, JoëlleUCLouvain
    Author
  • Saw, Jacqueline
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Abstract
OBJECTIVES: This study aimed to provide a systematic review of device-associated thrombosis (DAT) after left atrial appendage occlusion (LAAO) with the Watchman, Amplatzer Cardiac Plug, and Amulet devices. BACKGROUND: DAT is known as a complication of LAAO but data about its clinical impact is scarce. METHODS: A systematic review of studies evaluating the incidence, treatment and clinical implications of DAT from January 2008 to September 2015 was conducted. RESULTS: A total of 30 studies describing DAT events were included in the analysis. The overall incidence of DAT was 3.9% (82 DAT for 2118 implanted devices). The median time from procedure to diagnosis of DAT was 1.5 months (IQR: 0-2.9). Most cases were diagnosed with transesophageal echocardiogram (TEE). The treatment consisted of low molecular weight heparin (LMWH) in 45.5% of cases, and oral anticoagulation (OAC) or other treatment modalities in 54.5%. Complete thrombus resolution was achieved in 95.0% of cases (100% with LMWH and 89.5% with OAC). Treatment duration varied greatly with a median treatment duration of 45 days (IQR: 14-135). Clinical events related to DAT consisted of neurologic events namely two transient ischemic attacks (2.4%) and four ischemic strokes (4.9%). CONCLUSIONS: DAT is an infrequent complication of percutaneous LAAO. It occurs mainly early after the procedure and is associated with a low rate of neurological complications. In the majority of cases, diagnosis is made during follow-up imaging with TEE. Anticoagulation treatment seems to be safe and highly effective. Further studies are needed to evaluate the optimal management of DAT. © 2017 Wiley Periodicals, Inc.
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Lempereur, M., Aminian, A., Freixa, X., Gafoor, S., Kefer, J., Tzikas, A., Legrand, V., & Saw, J. (2017). Device-associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet. Catheterization and Cardiovascular Interventions, 90(5), E111-E121. https://doi.org/10.1002/ccd.26903 (Original work published 2017)