1 Introduction

Percutaneous left atrial appendage closure device (LAAC) is indicated in a selected group of patients with non-valvular AF who are intolerant to therapeutic anticoagulation [1] . The Watchman device (Boston Scientific, Marlborough, MA, USA) is a LAAC device that received FDA approval in 2015 after PROTECT AF trial showed non inferiority compared to warfarin for the incidence of stroke with significantly lower bleeding events in the device group [2] . Patients undergoing LAAC must be suitable for short term anticoagulation to mitigate the risk of device related thrombosis (DRT) until complete sealing of the device occurs [1] . The contemporary guidelines recommend aspirin and vitamin K antagonist (VKA) for 45 days post LAAC implantation, followed by aspirin and clopidogrel for 6 months from the procedure date. Then, lifelong aspirin is indicated thereafter [3] . Our patient represents an interesting case of persistent DRT despite being fully anticoagulated and in absence of any known risk factor for DRT.