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Cardiac Amyloidosis With Right Atrial Appendage Thrombus Detected After Left Atrial Appendage Occlusion

Year: 2025

Type: article

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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103383