Medical management of connector pin thrombosis with the Ampl
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Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device has become an alternative treatment for patients with atrial fibrillation at high embolism risk and with contraindications for chronic oral anticoagulation. The inadequate implantation of ACP and the discontinuation of double antiplatelet treatment are well-known as factors related to device thrombosis. Furthermore, device thrombosis after adequate implantation, requiring surgical treatment or restarting chronic OAC, has been reported and can reach 15% of patients. The connector pin thrombosis of the ACP, despite a good adherence to antiplatelet therapy, has been recently described as a potential mechanism for device thrombosis. The aim of this work is to describe the management of this serious complication after ACP device implantation.

A 79-year-old woman with ischemic heart disease, hypertension and diabetes mellitus presented with paroxysmal AF. The patient was under OAC because of a high embolism risk but had multiple admissions because of gastrointestinal bleeding of unknown cause, despite an intensive etiological study. To avoid long-term OAC, a percutaneous closure of the LAA with a 26-mm ACP device was performed and the patient was discharged under DAPT (aspirin 100 mg and clopidogrel 75 mg) until the 6th month. The post procedural transesophageal echocardiography (TEE) and the 45 d TEE revealed correct device positioning and the absence of thrombosis of the ACP.....