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Ju-P2: Sesión de pósteres II Lugar: Zona pósteres | |
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The role of anticoagulant therapy in device-related thrombus: A proof of concept study in left atrial appendage occlusion. 1: Departament d'Enginyeria, Universitat Pompeu Fabra (Barcelona).; 2: Department de cardiologia, Hospital Clínic de Barcelona (Barcelona). Background. Left atrial appendage occlusion (LAAO) prevents thromboembolic events in atrial fibrillation patients with bleeding risk, but device-related thrombosis (DRT) remains a challenge. Case summary. A 78-year-old man with atrial fibrillation (CHA₂DS₂-VASc = 3) and prior intracranial hemorrhage underwent successful LAAO with a 22-mm Amplatzer Amulet. After stepping down from apixaban to aspirin, DRT developed. Thrombi resolved with apixaban but recurred upon 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. Covering the pulmonary ridge and low-dose DOAC 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. | |