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Large left atrial thrombus formation despite warfarin therapy after device closure of a patent foramen ovale
Author(s) -
Cetta Frank,
Arruda M. Janine,
Graham Lynn C.
Publication year - 2003
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10542
Subject(s) - medicine , patent foramen ovale , thrombus , transesophageal echocardiogram , warfarin , thrombosis , cardiology , surgery , shunt (medical) , ventricular assist device , atrial fibrillation , transthoracic echocardiogram , heart failure , percutaneous
Abstract Appropriate anticoagulation after transcatheter device placement is controversial. Patients with no history of thromboembolism or neurologic event typically receive antiplatelet therapy for several months while the device endothelializes. For patients with a history of stroke, there are no established guidelines for postdevice anticoagulation. Most patients receive warfarin, antiplatelet therapy, or a combination. Thrombus formation after transcatheter device placement has been reported for most commercially available devices. We describe a patient who developed a left atrial thrombus after closure of a patent foramen ovale with a CardioSEAL device. The patient had a normal hypercoaguable laboratory evaluation prior to device placement. Thrombosis occurred despite warfarin therapy before and after device placement. The patient's international normalized ratio was checked every 2 weeks after device placement and ranged between 2.0 and 2.8. She had no clinical arrhythmia during this time period. The left atrial thrombus was detected on routine follow‐up transthoracic echocardiogram performed 6 months after device deployment. A subsequent transesophageal echocardiogram demonstrated no residual shunt, appropriate positioning of the device, flat against the septum, and a 1 × 2 cm thrombus attached to the superior and posterior left atrial arm near the junction with the native septum. A fluoroscopic image demonstrated no arm fractures. The device and thrombus were subsequently removed at surgery without complication. This case is perplexing in that the patient received appropriate anticoagulation had a negative hypercoaguable work‐up, no residual shunt, and a well‐positioned device. Cathet Cardiovasc Intervent 2003;59:396–398. © 2003 Wiley‐Liss, Inc.