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Light anti-thrombotic regimen after interatrial shunt device closure: A strategy for all patients?

  • Riccardo Cappato
    Affiliations
    Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano – Milan, Italy and Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele – Milan, Italy.
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Published:January 21, 2020DOI:https://doi.org/10.1016/j.ejim.2020.01.007
      During the recent years, catheter-based closure of atrial septal defect (ASD) or patent foramen ovale (PFO) has become an effective and safe therapy for the curative treatment of patients with hemodynamically significant inter-atrial shunts [
      • Baumgartner H
      • Bonhoeffer P
      • De Groot NM
      • de Haan F
      • Deanfield JE
      • Galie N
      • et al.
      ESC guidelines for the management of grown-up congenital heart disease (new version 2010).
      ]. Patients receiving this therapy present a peri-procedural risk of symptomatic thrombo-embolism of 1% to 2% [
      • Pristipino C
      • Sievert H
      • D'Ascenzo F
      • Mas JL
      • Meier B
      • Scacciatella P
      • Scacciatella P
      • Hildick-Smith D
      • Gaita F
      • Toni D
      • Thomson J
      • Derumeaux G
      • Onorato E
      • Sibbing D
      • Germonprè P
      • Berti S
      • Chessa M
      • Bedogni F
      • Dudek D
      • Hornung M
      • Zamorano J
      European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism.
      ] which raises to higher figures for asymptomatic episodes [
      • Sherman JM
      • Hagler DJ
      • Cetta F
      Thrombosis after septal closure device placement: a review of the current literature.
      ] and appears to be independent of the closure device used. In these patients, thrombus formation occurs more commonly in the setting of the procedure (through the delivery sheath or within the closure device). Nonetheless, clinical events due to cerebral or peripheral embolism have been reported months and even years after the intervention [
      • Raghu A
      • Kawalsky D
      • Feldman M
      Embolic stroke due to a left atrial thrombus two years after placement of an atrial septaldefect closure device.
      ].
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      1. Rigatelli G, Zuin M, Dell'Avvocata F, Roncon L, Vassilev D, Nghia N. Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic after interatrial shunts device-based closure. European J Int Med, In press (1,147).

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