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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.

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Lempereur, Mathieu Aminian, Adel Freixa, Xavier Gafoor, Sameer Kefer, Joëlle [UCL] Saw, Jacqueline

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.

Document type Article de périodique (Journal article) – Synthèse de littérature
Access type Accès restreint
Publication date 2017
Language Anglais
Journal information "Catheterization and Cardiovascular Interventions" - Vol. 90, no.5, p. E111-E121 (2017)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) New York, NY)
issn 1522-1946
e-issn 1522-726X
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - (SLuc) Service de cardiologie
MESH Subject Administration, Oral ; Anticoagulants ; Atrial Appendage ; Atrial Fibrillation ; Cardiac Catheterization ; Echocardiography, Transesophageal ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Ischemic Attack, Transient ; Risk Factors ; Septal Occluder Device ; Stroke ; Thrombosis ; Time Factors ; Treatment Outcome
Keywords complication ; left atrial appendage closure ; thrombosis
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Bibliographic reference Lempereur, Mathieu ; Aminian, Adel ; Freixa, Xavier ; Gafoor, Sameer ; Kefer, Joëlle ; et. al. 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.. In: Catheterization and Cardiovascular Interventions, Vol. 90, no.5, p. E111-E121 (2017)
Permanent URL http://hdl.handle.net/2078.1/204729