Explant of a thrombosed Watchman™ device after 48 days

Abstract

Over 150,000 Atrial fibrillation (AF) patients have been effectively treated by a left atrial appendage (LAA) closure device (Watchman™) for stroke prophylaxis (Kar et al., 2021). Many of these patients are able to successfully discontinue oral anticoagulation in 45 days after completing this minimally invasive procedure. However, no stroke prevention treatment option is without risk. The published rate of device-related thrombus is 3–4%, representing a rare but serious adverse event with a significantly increased risk for ischemic and recurrent stroke and death (Kar et al., 2021). The newer generation LAA occlusion devices have a reported DRT rate closer to 1.8% (Kar et al., 2021). We present a case of highly mobile thrombi noted at 45 days post device implant that required open surgical intervention given rapid change in size and increasing risk of embolization despite anticoagulation.