Provocative Cases -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-089 - First Documented Device-related Thrombus On Lifetech LAmbre Left Atrial Appendage Occluder Three Months After Implantation (ID 83)

Disclosure
 A. Füting: Nothing relevant to disclose.

Abstract

Background: Percutaneous left atrial appendage (LAA) closure is an alternative strategy for stroke prevention in AF patients not eligible for oral anticoagulation. The LAmbre is a novel occluder, adaptive to various anatomies (Fig., A+B).
Objective: We describe the first documented case of a device-related thrombus 3 months after implantation.
Results: A 84-year old man with permanent AF (CHA2DS2-VASc: 3, HAS-BLED: 4) and anaemia due to recurrent GI bleeding while on Edoxaban 30 mg q.d. was referred for LAA occluder implantation. A 22/34 mm LAmbre occluder was implanted. Edoxaban was replaced by Aspirin 100 mg q.d. and Clopidogrel 75 mg q.d. Follow-up was uneventful. After 3 months, a TEE showed correct occluder position, without visible gaps. A 18 x 8 mm thrombus (white arrow) was attached to the central part of the cover (Fig., C+D+E). A CT scan confirmed correct occluder position and presence, position and size of the thrombus (Fig., F). The patient confirmed strict daily medication compliance. There were no neurological deficits. Platelet function testing confirmed compliance with Aspirin and revealed that the patient is a low responder to Clopidogrel. Aspirin and Clopidogrel were replaced by Edoxaparin 0,8 mg b.i.d. After 6 weeks, another TEE showed complete resolution of the thrombus.
Conclusion: This is the first reported case of presence of a thrombus on the cover of a LAmbre LAA occluder, 3 months after implantation. Possible cause of the thrombus formation could be a confirmed low platelet response to Clopidogrel. However, device-related causes cannot be ruled out. The findings in this case could implicate that standard early platelet function testing might be advisable.
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