Challenges of left atrial appendage closure device and anticoagulation in a patient with immune thrombocytopenia (ITP)

Abstract

Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP). Patients with platelet disorders are at a higher risk for bleeding; however, that does not prevent such patients from thromboembolic events secondary to AF. We present a case of ITP with permanent AF, where an LAA device was complicated by thrombus formation due to challenges faced with anticoagulation therapy.

Left atrial appendage occlusion in patients with blood cell dyscrasia

“…In fact, certain BD disorders, such as immune thrombocytopenia, is well known to be paradoxically linked to thrombosis. 10 With increasing life expectancy, BD patients also have other comorbidities associated with high thrombogenicity (such as advanced age, diabetes mellitus, vascular complications, chronic inflammation, thereby resulting in a compensatory elevation in coagulation proteins leading to a relative hypercoagulable state), and frequently develop cardiovascular conditions requiring antithrombotic therapy, such as venous thrombosis, coronary artery disease and AF. 5,15 While the bleeding and thromboembolic risk assessment is a requisite in BD patients with AF, the decision to start antithrombotic agents is complex.…”

“…A total of eight studies incorporating a total of 32 BD patients undergoing LAAO were included in the analysis 3–10 . The mean age was 73.8±7.1 years, and 69% were men.…”

“…Outcomes A total of eight studies incorporating a total of 32 BD patients undergoing LAAO were included in the analysis. [3][4][5][6][7][8][9][10] The mean age was 73.8±7.1 years, and 69% were men. The mean CHA 2 DS 2 VASc and HAS-BLED scores were 4.1±1.8 and 3.1±1.3, respectively.…”