Key Information
Source
Year
2025
summary/abstract
Abstract
Background
Left atrial appendage occlusion (LAAO) is a valuable alternative therapy to anticoagulants for stroke prevention, and a representative study has demonstrated a high rate of anticoagulant discontinuation after LAAO.
Case Summary
LAAO was performed on an 88-year-old woman with cardiac amyloidosis (CA). Although anticoagulant therapy was discontinued after LAAO, a follow-up image showed a thrombus in the right atrial appendage (RAA) incidentally. Anticoagulation was resumed, and no clinical events were detected during a 1-year follow-up.
Discussion
Although LAAO is an effective treatment for stroke prevention in patients with CA, this condition is associated with an increased risk of intracardiac thrombus. Therefore, discontinuation of anticoagulant therapy after LAAO should be approached by keeping in mind the possibility of RAA thrombus.
Take-Home Messages
LAAO can be effective in CA, yet anticoagulation discontinuation must be individualized, keeping in mind the possibility of RAA thrombus in high-risk patients.
Key Words
atrial fibrillation
cardiac amyloidosis
left atrial appendage occlusion
Abbreviations and Acronyms
CA, cardiac amyloidosis; CKD, chronic kidney disease; LAAO, left atrial appendage occlusion; RAA, right atrial appendage; TEE, transesophageal echocardiography;
History of Presentation
An 88-year-old woman with cardiogenic cerebral infarction, despite taking edoxaban for chronic atrial fibrillation, was referred for percutaneous left atrial appendage occlusion (LAAO) to prevent recurrence. Her vitals were stable, and no significant findings were noted on physical examination. She was independent in activities of daily living with minimal neurologic sequelae and lived alone at home, even after the stroke. Her blood counts were normal, and laboratory tests indicated stage G4 chronic kidney disease (CKD) with a creatinine clearance of 18.4 mL/min.