# Massive Device-Related Thrombus After Left Atrial Appendage Closure in Kidney Transplant Recipient With Hypertrophic Cardiomyopathy

## TL;DR

A kidney transplant recipient with heart issues developed a large blood clot after a heart procedure, which was later successfully treated with a specific blood thinner.

## Contribution

Highlights the risk and management of device-related thrombus in HCM patients undergoing LAAC.

## Key findings

- A 59-year-old HCM patient developed a large thrombus after LAAC due to premature discontinuation of antiplatelet therapy.
- The thrombus resolved completely with a tailored rivaroxaban treatment regimen.
- LAAC may be a viable alternative for HCM patients with AF at high bleeding risk if managed carefully.

## Abstract

Although left atrial appendage closure (LAAC) provides a crucial stroke prevention alternative for patients with atrial fibrillation (AF) who cannot undergo long-term anticoagulation, concurrent hypertrophic cardiomyopathy (HCM) elevates the risk of device-related thrombosis (DRT) after the procedure.

This case report describes a 59-year-old woman with HCM, permanent AF, and a history of renal transplantation. Stroke prophylaxis was performed via LAAC with a 33-mm Watchman device. Premature discontinuation of dual-antiplatelet therapy 1 month postprocedure led to a large (5.2 cm × 2.5 cm) DRT identified at 6-month follow-up. The thrombus resolved completely after a prolonged, staged, and dose-adjusted course of rivaroxaban.

The efficacy and safety of LAAC for stroke prevention in patients with HCM and AF who cannot tolerate anticoagulation remain debated

Although LAAC is not a standard stroke prevention therapy for HCM patients with AF, it represents a viable alternative in high-bleeding-risk scenarios and requires meticulous planning, vigilant DRT surveillance, and individualized antithrombotic management.