Intracranial Hemorrhage during Dual Antiplatelet Therapy after Percutaneous Left Atrial Appendage Closure

patients with intracranial hemorrhage (ICH), it is a promising therapy, as anticoagulants are generally not advised. A recent study has shown that LAAO is safe and feasible in patients with AF and a previous history of ICH [4] . A strict echocardiographic follow-up protocol and dual antiplatelet therapy are recommended for at least 3 months to avoid thrombus formation on implantation of the device. However, this treatment increases hemorrhagic risk and has recently been associated with a fatal ICH after device implantation [5] . We report a case of symptomatic ICH and thrombus formation on the surface of the device in a patient taking dual antiplatelet therapy after LAAO. A 70-year-old patient with a history of AF on acenocoumarol for stroke prevention was admitted to the Stroke Unit with a left parieto-occipital hemorrhage. His INR was 2.3 and a cranial MRI ( fig. 1 a) showed a subacute lobar hemorrhage and multiple chronic microbleeds. As the bleeding risk was very high, anticoagulation was not restarted. Instead, he received 100 mg aspirin daily, and we offered the patient the possibility of LAAO, which he accepted. Percutaneous left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF) [1] . This approach has been proposed in patients with a higher risk of stroke [2] , contraindications for long-term anticoagulation therapy, and/or increased risk of bleeding [3] . In Published online: September 16, 2014