Trombosi residua in auricola sinistra post-chiusura chirurgica (AtriClip®) in paziente con fibrillazione atriale permanente

Atrial fibrillation is one of the main causes of cardioembolic stroke, frequently associated with thrombus formation in the left atrial appendage (LAA). Surgical LAA closure (LAAC) using the AtriClip® device is an effective and guideline-recommended strategy in patients undergoing cardiac surgery for other indications, with continuation of oral anticoagulation therapy where indicated. However, thrombus formation on the residual LAA stump, although rare, is a clinically significant complication. We report the case of an 80-year-old woman with permanent atrial fibrillation, heart failure, chronic kidney disease, and poor adherence to home oral anticoagulant therapy, who developed thrombosis on the LAA stump despite a previous AtriClip® occlusion. The diagnosis was established by transthoracic and transesophageal echocardiography, which revealed a thrombotic formation adherent to the wall of the LAA stump. The patient was initially treated with a reduced dose of apixaban, which had been previously discontinued in anticipation of a surgical procedure, and was subsequently switched to warfarin due to lack of efficacy based on imaging findings. Follow-up echocardiography later documented a modest reduction in thrombus size. This case emphasizes the importance of a personalized approach to antithrombotic therapy following LAAC and highlights the need to consider maintaining appropriate echocardiographic surveillance with long-term monitoring of oral anticoagulation therapy, if feasible.