CLINICAL CASE OF RESUMPTION OF ANTICOAGULANT THERAPY AFTER IMPLANTATION OF THE AMPLATZER CARDIAC PLUG LEFT ATRIAL APPENDAGE OCCLUDER
https://doi.org/10.21518/2307-1109-2019-1-82-91
Abstract
The article demonstrates a clinical case of forced renewal of anticoagulant therapy after the endovascular closure of the left atrial appendage. Patient with atrial fibrillation and high risk of thromboembolic complications and bleeding on the background of warfarin administration and inappropriate INR values had an acute hemorrhagic cerebral blood flow disorder developed. Endovascular closure of the left atrial appendage was performed. However, the thrombosis of the area of the delivery system fastening revealed after 12 months was an indication for the resumption of anticoagulant therapy.
The article presents modern data on the use of occluders for closing the left atrial appendage, the frequency of complications and antiplatelet therapy schemes depending on the presence of thrombosis risk factors and bleeding.
About the Authors
R. V. Guchaev
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
City Clinical Hospital named after V. V. Veresaev of the City of Moscow
Russian Federation
Russian Federation
cardiologist of the State Budgetary Healthcare Institution of Moscow
tel.: +7 (495) 483-50-33
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
D. V. Pevzner
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
Russian Federation
Russian Federation
Cand. of Sci. (Med), Head of the Intensive Care Unit of the Emergency Cardiology Department
tel: +7 (916) 748-33-77
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
E. V. Merkulov
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
Russian Federation
Russian Federation
Dr. of Sci. (Med), Senior Researcher, Head of the 1st Department of X-ray methods of diagnostics and treatment
tel: +7 (916) 748-33-77
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
M. I. Makeev
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
Russian Federation
Russian Federation
ultrasonic diagnostics doctor
tel: +7 (495) 414-68-84
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
N. S. Zhukova
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
Russian Federation
Russian Federation
Cand. of Sci. (Med), Senior Researcher of the Emergency Cardiology Department
tel: +7 (916) 748-33-77
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
R. M. Shakhnovich
Federal state budget organization «National medical research center of cardiology» of the Ministry of healthcare
Russian Federation
Russian Federation
Dr. of Sci. (Med), Professor, Leading Researcher of the Emergency Cardiology Department
tel: +7 (495) 150-44-19
121552, Russia, Moscow, 3rd Cherepkovskaya St., 15A
T. Yu. Vedenikin
City Clinical Hospital named after V. V. Veresaev of the City of Moscow
Russian Federation
Russian Federation
an anesthesiologist and intensive care specialist
tel.: +7 (495) 4849260
N. V. Shestakova
Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Continuing Professional Education» of the Ministry of Health
Russian Federation
Russian Federation
Cand. of Sci. (Med), Associate Professor of the Department of Cardiology
125993, Russia, Moscow, Barrikadnaya St., 2 / 1, b. 1
References
1. Kirchhof P., Benussi S., Kotecha Dipak et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European heart journal. 2016.
2. VNOA, RSC, RACVS Clinical Recommendations: Diagnostics and Treatment of Atrial Fibrillation, 2017. (In Russ.)
3. Hart R. G., Pearce L. A., Aguilar M. I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857-67.
4. Blackshear J. L., Odell J. A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755-9.
5. Ganeeva O. N. Left atrial appendage occlusion in atrial fibrillation. Patologiya krovoobrashcheniya i kardiohirurgiya. 2014;4:104-112. (In Russ.)
6. Meier B., Blaauw Y., Khattab A. A., Lewalter T., Sievert H., Tondo C., Glikson M. Document Reviewers. EHRA / EAPCI expert consensus statement on catheterbased left atrial appendage occlusion Europace. 2014 Oct;16 (10):1397-416.
7. Reddy V. Y., Holmes D., Doshi S. K., Neuzil P., Kar S. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation. 2011;123:417-24.
8. Saw J., Tzikas A., Shakir S. et al Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure With the Amplatzer Cardiac Plug. JACC Cardiovasc Interv. 2017 Feb 27;10 (4):391-39.
9. Holmes D. R. Jr, Kar S., Price M. J., Whisenant B., Sievert H., Doshi S. K., Huber K., Reddy V. Y. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64:1-12.
10. Main M. L., Fan D., Reddy V. Y. et al. Assessment of Device-Related Thrombus and Associated Clinical Outcomes With the WATCHMAN Left Atrial Appendage Closure Device for Embolic Protection in Patients With Atrial Fibrillation (from the PROTECT-AF Trial). Am J Cardiol. 2016 Apr 1;117 (7):1127-34.
11. Braut A., Neuzil P., Schuler G. et al. LAA closure with the Watchman device in patients with contraindications to warfarin: preliminary results from the ASA Plavix Registry (ASAP). Eur Heart J. 2011;32:6-7.
12. Sedaghat A., Schrickel J. W., Andrié R., Schueler R. Thrombus formation after left atrial appendage occlusion with the amplatzer amulet device. Am J Cardiol. 2016;118:1836-1841.
13. López-Minguez J. R., Eldoayen-Gragera J., González Fernández R. et al. Immediate and one-year results in 35 consecutive patients after closure of left atrial appendage with the Amplatzer Cardiac Plug. Rev Esp Cardiol. 2013;66:90-7.
14. Plicht B., Konorza T. F., Kahlert P. Risk factors for thrombus formation on the Amplatzer Cardiac Plug after left atrial appendage occlusion. JACC Cardiovasc Interv. 2013 Jun;6 (6):606-13.
15. Schwartz R. S., Holmes D. R., Van Tassel R. A. et al. Left atrial appendage obliteration: mechanisms of healing and intracardiac integration. J Am Coll Cardiol Intv. 2010;3:870-7.
16. Kar S., Hou D., Jones R. et al. Impact of WATCHMAN and Amplatzer devices on left atrial appendage adjacent structures and healing response in a canine model. J Am Coll Cardiol Intv. 2014;7:801-9.
17. Bass J. L. Transcatheter occlusion of the left atrial appendage – experimental testing of a new Amplatzer device. Catheter Cardiovasc Interv. 2010;76:181-5.
18. Park J. W., Bethencourt A., Sievert H. et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv. 2011;77:700-6.
19. Shakhmatova O. O. Problem of intracranial bleeding on the background of «new» oral anticoagulants. Aterotromboz. 2014;2:57-64. (In Russ.)
20. Ruff C. T., Giugliano R. P., Braunwald E. et al. Comparison of the effi cacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955-962.
21. Calemberg A. N. Optimization of treatment of patients with atrial fibrillation and high thromboembolic and hemorrhagic risk by comparing the conservative approach and implantation of a left atrial appendage occlusal device. Thes…. Сand. of Sci. (Med) 2015: 63-64. (In Russ.)
Review
For citations:
Guchaev R.V., Pevzner D.V., Merkulov E.V., Makeev M.I., Zhukova N.S., Shakhnovich R.M., Vedenikin T.Yu., Shestakova N.V. CLINICAL CASE OF RESUMPTION OF ANTICOAGULANT THERAPY AFTER IMPLANTATION OF THE AMPLATZER CARDIAC PLUG LEFT ATRIAL APPENDAGE OCCLUDER. Aterotromboz = Atherothrombosis. 2019;(1):82-91. (In Russ.) https://doi.org/10.21518/2307-1109-2019-1-82-91
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