A 69-year-old gentleman, with past medical history of recurrent cardio-embolic cerebrovascular accidents (2 episodes), coronary artery disease – status post PCI, nonvalvular atrial fibrillation, and history of abdominal Koch’s with diffuse gastrointestinal ulceration, approached us seeking help to manage his stroke vs. bleeding risk. He was not able to tolerate oral anticoagulants well and had a history of multiple hospital admissions with G.I. blood loss. On the last occasion, when he had defaulted on anticoagulants during an episode of G.I. bleeding, he had suffered an ischemic stroke. We discussed the non-pharmacological options to prevent further cerebrovascular accidents with the patient and his relatives, and they opted for left atrial appendage closure device.
On April 13, under general anaesthesia, with transesophageal echo and fluoroscopic guidance, left atrial appendage closure was done with AMPLATZER™ cardiac plug by our team of doctors. The procedure went well, and the patient was discharged on the following day.
On follow-up, the patient is doing well with no recurrence of ischemic cerebrovascular accidents or any G.I. bleeding. The patient is extremely happy with the discontinuation of oral anticoagulants. This procedure opens up a new avenue of managing stroke in nonvalvular atrial fibrillation, which otherwise requires oral anticoagulation and is at high risk of bleeding accidents, secondary to oral anticoagulation. Team CNH is proud to participate in bringing this new innovation into the mainstream. CNH is only the third centre in Bangalore to perform this procedure and our team remains committed to bringing more innovative therapies for needy patients in the future.