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
| Autor: | Adel Aminian, Mathieu Lempereur, Apostolos Tzikas, Sameer Gafoor, Jacqueline Saw, Xavier Freixa, Joelle Kefer, Victor Legrand |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class medicine.medical_treatment Low molecular weight heparin 030204 cardiovascular system & hematology Transesophageal echocardiogram Left atrial appendage occlusion 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Radiology Nuclear Medicine and imaging 030212 general & internal medicine Thrombus Stroke Cardiac catheterization medicine.diagnostic_test business.industry Atrial fibrillation General Medicine medicine.disease Thrombosis Surgery Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Catheterization and Cardiovascular Interventions. 90:E111-E121 |
| ISSN: | 1522-1946 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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