Transient Ischemic Attack Secondary to Device-Related Thrombus After Left Atrial Appendage Closure

The patient is an 84-year-old female with a significant past medical history of traumatic subarachnoid hemorrhage, bleeding peptic ulcer disease, permanent atrial fibrillation status post percutaneous left atrial appendage closure (LAAC) initially admitted to the hospital secondary to expressive aphasia. The patient was found to have a transient ischemic attack (TIA). A transesophageal echocardiogram (TEE) showed a thrombus on the watchman device (WD). The patient was treated with unfractionated heparin infusion and later transitioned to apixaban without any further TIA or stroke over 30 days period. Device-related thrombosis (DRT) with systemic thromboembolism occurred almost after 480 days of putting the WD which is very rare.