JACC. Case reports · 2025
The Role of Anticoagulants After Left Atrial Appendage Occlusion.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Segarra-Queralt Maria, Molla Marc, Barrouhou Manal, Olivares Andy L, Albors Carlos, Bernardino Gabriel, Regueiro Ander, Mill Jordi, Càmara Òscar, Freixa Xavier
Аннотация
BACKGROUND: Left atrial appendage occlusion prevents thromboembolic events in atrial fibrillation patients with bleeding risk, but device-related thrombosis (DRT) remains a challenge.
CASE SUMMARY: A 78-year-old man with atrial fibrillation (CHA2DS2-VASc score = 3) and prior intracranial hemorrhage underwent successful left atrial appendage occlusion with a 22-mm Amplatzer Amulet. After stepping down from apixaban to aspirin, DRT developed. Thrombi resolved with apixaban but recurred on its discontinuation. A multiscale model integrating hemodynamics, thrombus formation events, and apixaban revealed fibrin buildup beneath the pulmonary ridge, matching clinical thrombus. Optimized placement alone prevented fibrin formation in the virtual model.
DISCUSSION: Pulmonary ridge coverage and low-dose direct oral anticoagulants have emerged as effective strategies to reduce DRT. This case links both mechanisms, showing recurrence due to incomplete ridge coverage and antithrombotic decision.
TAKE-HOME MESSAGES: Our high-fidelity model offers mechanistic insight about antithrombotic therapy, which cannot be assessed with flow-based simulations alone. The results presented provide proof-of-concept evidence of the model's capabilities.
CASE SUMMARY: A 78-year-old man with atrial fibrillation (CHA2DS2-VASc score = 3) and prior intracranial hemorrhage underwent successful left atrial appendage occlusion with a 22-mm Amplatzer Amulet. After stepping down from apixaban to aspirin, DRT developed. Thrombi resolved with apixaban but recurred on its discontinuation. A multiscale model integrating hemodynamics, thrombus formation events, and apixaban revealed fibrin buildup beneath the pulmonary ridge, matching clinical thrombus. Optimized placement alone prevented fibrin formation in the virtual model.
DISCUSSION: Pulmonary ridge coverage and low-dose direct oral anticoagulants have emerged as effective strategies to reduce DRT. This case links both mechanisms, showing recurrence due to incomplete ridge coverage and antithrombotic decision.
TAKE-HOME MESSAGES: Our high-fidelity model offers mechanistic insight about antithrombotic therapy, which cannot be assessed with flow-based simulations alone. The results presented provide proof-of-concept evidence of the model's capabilities.