Device related thrombosis after left atrial appendage occlusion: does thrombus location always predicts its origin?

Flores‐Umanzor, Eduardo; Cepas-Guillén, Pedro; Sanchís, Laura; Regueiro, Ander; Navarro, Ricard; Brugaletta, Salvatore; Vidal, Bárbara; Sitges, Marta; Sabaté, Manel; Freixa, Xavier

doi:10.1007/s10840-020-00819-6

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…These harmful hemodynamic conditions were generally found in the upper region of the device, in agreement with the literature, which reports that 82% of DRT cases involve an uncovered left upper pulmonary ridge [16,17]. However, depending on the individual morphological characteristics, uncovering the pulmonary ridge may not lead to DRT.…”

Section: Discussionsupporting

confidence: 90%

“…In our simulations, re-circulations at low blood flow velocities that may promote flow stagnation and can trigger the inflammatory process [42], were mainly found in LAAO devices positioned deeply into the LAA cavity (e.g., distal to the LAA ostium), independently of the device type. These harmful hemodynamic conditions were generally found in the upper region of the device, in agreement with the literature, which reports that 82% of DRT cases involve an uncovered left upper pulmonary ridge [16, 17]. However, depending on the individual morphological characteristics, uncovering the pulmonary ridge may not lead to DRT.…”

Section: Discussionsupporting

confidence: 89%

“…Despite the described simplifications of the modeling pipeline and the limitations of some in-silico hemodynamic indices, it was still useful to compare different LAAO device configurations in each individual, and analyse the impact of covering the pulmonary ridge with the LAAO device, as a preventive factor reducing the risk of DRT, as reported by Freixa et al (2021) [16]. In our simulations, re-circulations at low blood flow velocities that may promote flow stagnation and can trigger the inflammatory process [42], were mainly found in LAAO devices positioned deeply into the LAA cavity (e.g., distal to the LAA ostium), independently of the device type.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis by Alkhouli et al (2022) [15] reports an incidence of DRT in 4-6% of the cases. The causes leading to DRT may potentially be attributed to various factors, including post-procedural complications (e.g., incomplete device endothelialization), demographic and clinical characteristics (e.g., comorbidities, age-dependency), deep-device-LAA implantation uncovering the pulmonary vein ridge (i.e., > 10 mm distance from the Left Superior Pulmonary Vein (LSPV) ridge) or device type (i.e., pacifier-and plug-type devices) [15][16][17]. While the clinical routine presents the benefits of anticoagulation for clot prophylaxis, there is not a consensus on the ideal drug therapy (i.e., drug choice, dosage, timings) following device implantation, being DRT management still a clinical unsolved problem.…”

Section: Introductionmentioning

confidence: 99%

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Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Albors,

Mill,

Olivares

et al. 2024

Preprint

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Left atrial appendage occlusion devices (LAAO) are a feasible alternative for non-valvular atrial fibrillation (AF) patients at high risk of thromboembolic stroke and contraindication to antithrombotic therapies. However, optimal LAAO device configurations (i.e., size, type, location) remain unstandardized due to the large anatomical variability of the left atrial appendage (LAA) morphology, leading to a 4-6% incidence of device-related thrombus (DRT). In-silico simulations have the potential to assess DRT risk and identify the key factors, such as suboptimal device positioning. This work presents fluid simulation results computed on 20 patient-specific left atrial geometries, analysing different commercially available LAAO occluders, including plug-type and pacifier-type devices. In addition, we explored two distinct device positions: 1) the real post-LAAO intervention configuration derived from follow-up imaging; and 2) one covering the pulmonary ridge if it was not achieved during the implantation (13 out of 20). In total, 33 different configurations were analysed. In-silico indices indicating high risk of DRT (e.g., low blood flow velocities and flow complexity around the device) were combined with particle deposition analysis based on a discrete phase model. The obtained results revealed that covering the pulmonary ridge with the LAAO device may be one of the key factors to prevent DRT. Moreover, disk-based devices exhibited enhanced adaptability to various LAA morphologies and, generally, demonstrated a lower risk of abnormal events after LAAO implantation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Albors,

Mill,

Olivares

et al. 2024

Preprint

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“…Both premises might suggest that apixaban could be more appropriate than any antiplatelet therapy to reduce this thrombotic risk. In fact, our hypothesis that low-dose apixaban is a valid strategy to prevent DRT while keeping a low risk of bleeding is based on two facts: (1) excluding the LAA from the circulation would eliminate the main reservoir of thrombus from the body, so lower anticoagulation dose should be indeed necessary; and (2) the successful treatment of DRT with low-dose apixaban observed by our group in previous reports [24].…”

Section: Low-dose Noac Showed a Similar Efficacy Profile Compared To Sapt Or Daptmentioning

confidence: 87%

Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion

Cepas-Guillén

Flores‐Umanzor

Regueiro

et al. 2021

JCDD

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The optimal antithrombotic strategy following left atrial appendage occlusion (LAAO) is not yet clearly established. Low-dose non-vitamin K antagonist oral anticoagulants (NOAC) might represent a valid alternative, but data regarding their usage is scarce. The aim of this study was to examine the efficacy and safety of low-dose NOAC compared to single (SAPT) or dual antiplatelet therapies (DAPT) after LAAO. We included consecutive patients with non-valvular atrial fibrillation who underwent LAAO and received low-dose apixaban, SAPT, or DAPT at discharge. The primary objective of this study included an efficacy endpoint (thromboembolic events and device related thrombosis (DRT)) and a safety endpoint (incidence of major bleeding) within the first three months after LAAO. A total of 139 patients were included. This group involved SAPT in 26 (18%), DAPT in 73 (53%), and apixaban in 40 (29%) patients. Follow-up at three-months showed no significant differences in the primary efficacy endpoint (2 (8%) SAPT, 3 (4%) DAPT and 0 (0%) apixaban; p value = 0.25). In contrast, the primary safety endpoint occurred more frequently in DAPT patients (7 (10%) DAPT, 0 (0%), SAPT and 0 with apixaban; p value = 0.03). Combining both efficacy and safety outcomes, low dose apixaban had a lower rate of events (2 (8%) with SAPT, 9 (12%) with DAPT and 0 (0%) with apixaban; p = 0.046). Low-dose apixaban after LAAO may be a valid alternative to DAPT and SAPT as depicted by the reduction in the occurrence of major bleedings and combined DRT/major bleedings respectively. Randomized data will be necessary to validate this strategy.

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Impact of Blood Rheological Strategies on the Optimization of Patient-Specific LAAO Configurations for Thrombus Assessment

Albors

Olivares

Iriart

et al. 2023

Lecture Notes in Computer Science

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Device related thrombosis after left atrial appendage occlusion: does thrombus location always predicts its origin?

Cited by 6 publications

References 8 publications

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion

Impact of Blood Rheological Strategies on the Optimization of Patient-Specific LAAO Configurations for Thrombus Assessment

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