Uddin Mohammed M, Pervez Eskara, Usama Muhammad, Mir Tanveer, Regmi Neelambuj, Kottam Anupama
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
BMJ Case Rep. 2021 Mar 25;14(3):e241985. doi: 10.1136/bcr-2021-241985.
Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP). Patients with platelet disorders are at a higher risk for bleeding; however, that does not prevent such patients from thromboembolic events secondary to AF. We present a case of ITP with permanent AF, where an LAA device was complicated by thrombus formation due to challenges faced with anticoagulation therapy.
在因血液系统疾病而有高出血风险的心房颤动（AF）患者中，左心耳（LAA）封堵治疗已被证明是长期口服抗凝以预防血栓栓塞性中风的一种极佳替代方法。然而，术后与器械相关的血栓形成仍是一个主要问题，这可能导致危及生命的栓塞事件。迄今为止，对于接受LAA封堵治疗的血液系统疾病患者，尤其是患有免疫性血小板减少症（ITP）等血小板疾病的患者，尚无关于其选择和管理的系统性指南。血小板疾病患者出血风险更高；然而，这并不能阻止此类患者发生继发于AF的血栓栓塞事件。我们报告一例患有永久性AF的ITP患者，该患者因抗凝治疗面临挑战，LAA装置出现血栓形成并发症。
