Device-Related Thrombus After Percutaneous LA Appendage Occlusion

Nov 09, 2018
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Authors:
Alkhouli M, Busu T, Shah K, Osman M, Alqahtani F, Raybuck B.
Citation:
Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion: A Meta-Analysis. JACC Clin Electrophysiol 2018;Oct 31:[Epub ahead of print].
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

What is the incidence and clinical impact of device-related thrombus (DRT) following percutaneous left atrial appendage occlusion (LAAO)?

Methods:

The authors performed a meta-analysis of randomized and observational studies of LAAO. Outcomes are reported as a pooled incidence of DRT and pooled odds ratio (OR) of ischemic events.

Results:

Among 66 included studies, the incidence of DRT was 351/10,153 (3.8%, range 0%-17%). The diagnosis was most commonly made between 90 and 365 days post-implantation (57%) followed by 0 to <90 days post-implantation (42%) and >365 days post-implantation (1%). There was no difference in DRT incidence between the AMPLATZER and WATCHMAN devices (3.6% vs. 3.1%, p = 0.24). The pooled incidence of ischemic events was 13.2% in patients with DRT vs. 3.8% in patients without DRT (OR, 5.27; 95% confidence interval, 3.66-7.59).

Conclusions:

The authors concluded that DRT after LAAO is uncommon (3.8%), but is associated with a 4- to 5-fold increased risk of ischemic events.

Perspective:

LAAO implantation has become an increasingly used strategy for stroke prevention in patients with atrial fibrillation, especially those who cannot take (or do not wish to take) long-term anticoagulation. This meta-analysis confirms that DRT complicating LAAO implantation occurs in approximately 4% of patients. Among patients who develop DRT, ischemic event rates (including stroke) are quite high and require ongoing anticoagulation therapy. Further studies aimed at identifying which patients are likely to develop DRT and strategies to prevent its formation are needed.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Cardiology Interventions, Coronary Occlusion, Myocardial Ischemia, Risk, Secondary Prevention, Stroke, Thrombolytic Therapy, Thrombosis, Vascular Diseases


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