After percutaneous left atrial appendage occlusion (LAAO), device-related thrombus (DRT) may be associated with an increase in ischemic events, according to a study published July 19 in the Journal of the American College of Cardiology.

Trevor Simard, MD, et al., looked at data from a large multicenter international registry to evaluate clinical outcomes and DRT predictors in 711 patients who underwent LAAO. The study incorporated data from 37 international centers on LAAO cases with and without DRT presence detected. The researchers also assessed the management patterns, mid-term results, and procedural indicators of DRT.

Out of the 711 patients in the study, 237 of the participants had DRT, and 474 did not. The results showed that DRT presence correlated with an increased risk of the composite endpoint of ischemic stroke, systemic embolization, or death. In the most recent follow-up, DRT presence was found in 25.3% of the patients, and LAAO discharge medications did not affect DRT. The researchers identified five risk factors of DRT: hypercoagulability disorder, pericardial effusion, renal insufficiency, implantation depth >10 mm from the pulmonary vein limbus, and non-paroxysmal atrial fibrillation.

The authors conclude that the study “confirms the association of DRT with major ischemic events, and the resolution of DRT with [oral anticoagulation] treatment in most patients,” and “identifies novel patient-specific and procedural factors that are associated with the development of DRT while synthesizing this into a clinical risk score to improve risk stratification.”

In a related editorial comment, Oussama Wazni, MD, et al., note that “the study sheds light on this yet unresolved issue and the observations may help with risk stratification and optimization of procedural techniques.” They add that, “as the field grows wider, enhancing LAAO safety with optimal design, implantation, and periprocedural management is critically important; yet, the main focus should remain on optimal patient selection for the purpose of achieving safe and successful outcomes.”

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Pericardial Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Pulmonary Veins, Atrial Appendage, Pericardial Effusion, Brain Ischemia, Stroke, Thrombosis, Risk Factors, Blood Coagulation, Anticoagulants, Renal Insufficiency, Atrial Fibrillation

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