Work

The Role of Anticoagulants After Left Atrial Appendage Occlusion

Year: 2025

Type: article

Abstract: 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: -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.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105838