# The Amulet Device as Rescue Therapy in a Patient With Atrial Fibrillation and a Recurrent Gastrointestinal Bleed: A Case Report

## TL;DR

A 73-year-old woman with atrial fibrillation and a history of gastrointestinal bleeding successfully had a device implanted to prevent stroke when anticoagulants were not an option.

## Contribution

Demonstrates the Amulet device as a safe rescue therapy for stroke prevention in patients with atrial fibrillation and contraindications to anticoagulation.

## Key findings

- The Amulet device provided an effective mechanical solution for stroke prophylaxis in a high-risk patient.
- The procedure was uncomplicated and allowed discharge on short-term antiplatelet therapy.
- This case highlights a successful alternative to long-term anticoagulation in managing thrombotic and hemorrhagic risks.

## Abstract

In patients with non-valvular atrial fibrillation (AF) and a high stroke risk, long-term oral anticoagulation (OAC) is the standard of care. However, this becomes unfeasible in the presence of life-threatening bleeding, creating a significant therapeutic challenge. Percutaneous left atrial appendage occlusion (LAAO) offers a non-pharmacological alternative for stroke prevention. A 73-year-old female with persistent AF (CHA₂DS₂-VASc score of 6), end-stage renal disease on hemodialysis, and recurrent gastrointestinal (GI) bleeding was evaluated. Her GI workup suggested arteriovenous (AV) malformations of the small bowel. The patient's clinical course was complicated by recurrent hemorrhage despite a brief resumption of anticoagulant therapy, ultimately making long-term OAC an unsuitable strategy. She successfully underwent percutaneous LAAO with a 25 mm Amulet device (Abbott Medical, Chicago, IL, US). The procedure was uncomplicated, and she was discharged on a short course of dual antiplatelet therapy. This case demonstrates that the Amulet LAAO device is a safe and effective "rescue" strategy for stroke prophylaxis in patients with AF and an absolute contraindication to anticoagulation. It provides a definitive mechanical solution, resolving the critical conflict between thrombotic and hemorrhagic risks.