Device-Related Thrombus: A Reason for Concern?

Hannawi, Bashar; Beg, Faheemullah; Valderrábano, Miguel; Kurrelmeyer, Karla M.

doi:10.14797/mdcj-15-1-77

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…The most common cause of DRT has been noted to occur following the discontinuation of oral anticoagulant therapy [ 6 ]. At this time, there is no indication of which oral anticoagulant is preferred as one retrospective study suggested that there was no significant difference in developing DRT with the initial use of either vitamin K antagonists or direct oral anticoagulants [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In patients for whom anticoagulation is contraindicated, device implantation to close off the left atrial appendage (LAA) is the next likely choice in intervention and has become a leading alternative option for therapeutic prevention of thromboembolism; several devices have been developed for this use ( Table 1 ) [ 5 ]. Unfortunately, some of these devices have been associated with about a 3-6% incidence of intracardiac thrombus development postimplantation despite the use of anticoagulant therapy [ 6 ]. In this report, we present a case of an elderly male who was found to develop a large device-related thrombus in his left atrium five months following placement of a WATCHMAN device.…”

Section: Introductionmentioning

confidence: 99%

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Large Device-Related Thrombus Detected following Symptoms of Transient Ischemic Attack

Lawani

Baptista²

2021

Case Reports in Cardiology

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As an independent risk factor for stroke, atrial fibrillation has been shown to be associated with a fivefold increase in the cause of embolic stroke in comparison to healthy individuals without atrial fibrillation. This risk may be compounded by other factors; however, the main probable cause of stroke leading from atrial fibrillation is thrombus formation in the left atrial appendage. In patients for whom anticoagulation is contraindicated, left atrial appendage occlusion has become a leading alternative option for therapeutic prevention of thromboembolism and stroke in patients with this condition. Unfortunately, these devices (particularly the WATCHMAN) have been associated with a 3-6% incidence of intracardiac thrombus development postimplantation. Some risk factors for the development of device-related thrombus are high platelet count, permanent atrial fibrillation, resistance to clopidogrel, and prior transient ischemic attack or stroke. Despite following an anticoagulant regimen, thrombus formation was reported in 5.6% of participants of a randomized clinical trial, and further analysis showed that some of these patients continued to develop either ischemic stroke or thromboembolism five years later as compared to patients without initial thrombus development. We present a case of an elderly male with prior history of stroke and transient ischemic attack who developed a large device-related thrombus five months following WATCHMAN FLX™ implantation. Currently, there are no specific recommendations on the management of this rare complication; however, we discuss possible consideration of initially prolonging anticoagulation therapy following implantation for high-risk individuals, as there is an increased possibility for thrombus formation in this population. Management options should continue to be studied for therapeutic benefit in streamlining postprocedural therapy and improve future outcomes in the use of left atrial appendage occlusion devices, as well as continual thrombus prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Large Device-Related Thrombus Detected following Symptoms of Transient Ischemic Attack

Lawani

Baptista²

2021

Case Reports in Cardiology

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“…Although measures are taken to prevent complications, implants may be associated with chronic inflammation, ,, infection, − failure of integration, fatigue, implant failure, leak, degradation and particle release, − migration, − thrombosis, obstruction and occlusion, − and lack of remodeling, responsiveness, and sensing capability (Figure , Table ), and managing these problems can benefit from integrating appropriate sensors to implants to enable their early detection (Table ).…”

Section: Current Implants Problems and Limitationsmentioning

confidence: 99%

“…Devices that come in contact with blood, such as stents and ports, may be complicated by thrombosis in 18% of patients. , Thrombosis may lead to complete occlusion of vessels, with subsequent distal ischemia that leads to death of the downstream tissue or patient death, such as may occur in myocardial infarction . Although stents have been laced with drugs that can prevent tissue growth and thrombosis, studies have revealed that thrombosis may still occur .…”

Section: Current Implants Problems and Limitationsmentioning

confidence: 99%

Implants with Sensing Capabilities

et al. 2022

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Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.

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“…In those who risk of bleeding outweighs the benefit, left atrial appendage closure device, such as the watchman, is a great alternative and has been shown to be noninferior in the PROTECT AF study 1 . It, however, does carry its own risk such as device‐related thrombus 2 …”

Section: Casementioning

confidence: 99%