![]() ![]() Anticoagulation remains the standard therapy in patients with low bleeding risk, whereas the use of antiplatelet agents may be indicated in some clinical settings when the risk of thromboembolism is balanced by the risk of bleeding. Further studies are needed to evaluate the clinical impact of these predisposing factors.Ĭurrently, the optimal antithrombotic regimen and its duration after Watchman implantation is still under debate and might be patient-specific. Predisposing factors for development of DAT are multifactorial and include patient characteristics, echocardiographic findings, procedural results, and device-related factors. Therefore, antithrombotic treatment after LAA occlusion is currently recommended. Moreover, in cases of DAT, intensification of antithrombotic therapy was required to resolve the thrombus, which may increase the risk of a bleeding complication. 2 Although most patients diagnosed with DAT are asymptomatic at the time of diagnosis, DAT can be associated with thromboembolic events (mostly neurologic). In a recent review, the rate of device-associated thrombosis (DAT) after LAA occlusion with Watchman was 3.4%. Based on the postimplantation treatment protocols from the PROTECT AF and PREVAIL trials, the vast majority of Watchman implantations described in the literature were accompanied by warfarin anticoagulation for 45 days, followed by dual antiplatelet therapy (DAPT) for 6 months postprocedure and aspirin thereafter. ![]() Ideally, antithrombotic therapy should be pursued until complete occluder endothelialization occurs. The implantation of thrombogenic devices in patients with nonvalvular AF who are at high risk of thrombosis in the left atrium requires antithrombotic therapy to prevent on-device thrombus formation ( Figure 1). 2015 16:1198–1206, by permission of Oxford University Press.Īfter LAA closure with the Watchman device, thrombosis may appear on the surface of the device. Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure. ![]() Reprinted from Saw J, Fahmy P, DeJong P, et al. Contrast-enhanced CT images revealing an atrialside device thrombus on a Watchman device at the fabric insert (white arrow) and adjacent to the device (black arrow). ![]()
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