Post procedural management and follow up
Post procedural anti-thrombotic management is also listed inTable 2 . All patients were discharged on post-procedural day 1. The two patients who received a WATCHMAN device were discharged with aspirin and an anticoagulant. One patient who received an Amplatzer had been noted previously to have a LAA thrombus that resolved with apixaban, and he was maintained on apixaban after device placement. The two other patients who had an Amplatzer placed were discharged on ASA and clopidogrel (Table 2 ).
Follow up TEE was performed ≥ 6 weeks after device placement. In the 4 ISLL patients, no residual leaks were noted and no device related thrombus was present. In the fifth patient who had a WATCHMAN and Amplatzer in place, a small leak was noted by TEE (< 4mm) with no thrombus. Patients on an anticoagulant were transitioned to aspirin/clopidogrel for an additional 6 weeks, then transitioned to aspirin monotherapy. The median follow up time since closure of the residual connection was 888 days (range 468 – 1490 days). No strokes or systemic embolic events occurred. One patient had recurrent GIB requiring transfusion on dual antiplatelet therapy 8 weeks after device placement and clopidogrel was stopped.