First description of atrial fibrillation and congenital thrombotic thrombocytopenic purpura treated by left atrial appendage occlusion

Hussain Basrawala; Katherine Finley; Michael Jaglal; Bibhu D Mohanty

doi:10.1002/jha2.659

First description of atrial fibrillation and congenital thrombotic thrombocytopenic purpura treated by left atrial appendage occlusion

EJHaem. 2023 Mar 3;4(2):428-431. doi: 10.1002/jha2.659. eCollection 2023 May.

Authors

Hussain Basrawala¹, Katherine Finley², Michael Jaglal³, Bibhu D Mohanty¹

Affiliations

¹ Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine Tampa Florida USA.
² Department of Internal Medicine, University of South Florida Morsani College of Medicine Tampa Florida USA.
³ Department of Hematology and Oncology, University of South Florida Morsani College of Medicine Tampa Florida USA.

Abstract

Given an increased risk of both thrombosis and bleeding, thrombotic thrombocytopenic purpura (TTP) presents a unique challenge when anticoagulation is required for comorbid disease, particularly in the setting of major bleeding events. We present for the first time a patient with TTP and atrial fibrillation, presenting with recurrent stroke, but unable to tolerate anticoagulation due to prior intra-cerebral hemorrhage. To address both issues concomitantly, we describe the successful application of a novel management approach to facilitate left atrial appendage occlusion, there by offering a non-pharmacologic means of stroke prevention without added bleeding risk.

Keywords: Anticoagulation; LAAO; TTP; Watchman; atrial fibrillation; left atrial appendage; occlusion; purpura; stroke; thrombocytopenia; thrombocytopenic; thromboembolic; thrombosis; thrombotic.