Embolizing Massive Right Atrial Thrombus in a HIV-Infected Patient

Natarajan, Preethi; Joolhar, Fowrooz; Thangarasu, Sudhagar; Aboeed, Ayham; Win, Theingi Tiffany; Cobos, Everardo

doi:10.1177/2324709618802871

Cited by 4 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, in our series, 12 cases of left ACT were associated with mitral prosthetic valve and stenosis, in the presence of a “valvular-AF.” In the other cases of extra-LAA thrombosis, a co-pathology predisposing to thrombophilia was always present [ Table 3 ]. Therefore, excluding cases related to mitral stenosis, a prosthetic valve, and invasive electrophysiological procedures,[ 19 20 ] when a clot forms inside the atrial cavities, a condition of hypercoagulability is quite always present: septic shock, acquired immunodeficiency syndromes, tumors, autoimmunity disorders, congenital or acquired Protein C or S deficiency, heparin cofactor II or antithrombin deficiency, plasmin disorders, and increased levels of proinflammatory cytokines[ 21 22 ] [ Supplementary Table 1 ]. AF is not a necessary condition, as described cases in sinus rhythm demonstrate.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombus regression is usually achieved by full dose anticoagulation (IV or low-molecular-weight heparin, or warfarin)[ 32 ] which has been documented even with direct oral anticoagulants such as dabigatran. [ 21 ] In our series, we preferred IV heparin followed by warfarin, but two of our patients had to undergo surgical clot removal due to a very high embolic risk [ Figure 1 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review

Cresti¹,

Baratta²,

Aloia³

et al. 2023

Journal of Cardiovascular Echography

View full text Add to dashboard Cite

Background: Atrial tachyarrhythmias are the main cause of atrial thrombosis, and are usually in the left appendage. The prevalence and causes of endocavitarian thrombosis have not been investigated in recent large-scale studies. Aim of our work was to describe the epidemiology, the clinical characteristics and predisposing factors of “extra-appendicular” atrial thrombosis and to report a systematic review of recent literature. Methods and Results: 5,862 consecutive adult patients referred to a transesophageal echocardiographic exam, were enrolled. A total of 175 subjects with Atrial Thrombosis were found with a prevalence of 2.98%; among those 22 was found in left (0.38%) and 2 in the right (0.03%) atrium. Among the 22 patients with left atrial thrombosis, 8 were associated with prosthetic valves, 4 with mitral stenosis and the remaining with hypercoagulative conditions (cancer, septic shock, eosinophilic pneumonia, cardiogenic shock and warfarin under-dosage in permanent atrial fibrillation and decompensated heart failure). Cancer was associated in one of the two patients with a right atrial clot. The review of the literature from 2000 to December 2019 revealed conflicting results of 48 case reports of atrial cavity thrombosis; pooling this data proved the rarity of extra-appendage thrombosis and confirmed its association with a valvular heart disease or a systemic hypercoagulable state. Conclusions: Atrial “extra-appendage” thrombosis is a rare condition usually associated to “valvular” atrial fibrillation (such as prosthetic valves and mitral stenosis). A minority, but significant, cases are secondary to a thrombophilic conditions. In absence of valvular heart disease an underlying condition should be sought.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review

Cresti¹,

Baratta²,

Aloia³

et al. 2023

Journal of Cardiovascular Echography

View full text Add to dashboard Cite

show abstract

“…Since there is a possibility of interactions between warfarin and antiretroviral therapy, health care providers should be watchful of consequent dangerously high or low INRs when giving warfarin to patients undergoing antiretroviral therapy 1 . It is shown that newer anticoagulants can be used with antiretroviral therapy without any noticeable interactions 15 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Dilated cardiomyopathy with biventricular thrombus secondary to impaired coagulation in a patient with HIV

Kammari

Rallabandi

et al. 2020

F1000Res

View full text Add to dashboard Cite

Human immunodeficiency virus (HIV) infection is a known hypercoagulable state with venous thromboembolism with a high mortality rate compared to the general population. The homeostatic balance in HIV infected patients improves with treatment compared to those who are not. A decreased hypercoagulable state noted by low levels of Von Willebrand factor, factor VIII and d-dimer levels along with higher protein C and S activity in patients on treatment suggests that hypercoagulable state is partially correctable with highly active antiretroviral therapy. HIV with heart muscle involvement can present as myocarditis or as dilated cardiomyopathy with left or right ventricular dysfunction. Here we present a case of a 57-year-old man with a known history of HIV infection, noncompliant with medical therapy presenting with dilated cardiomyopathy with biventricular thrombi with reduced protein C, protein S, and Antithrombin III levels.

show abstract

“…The inherited hypercoagulable states include protein C and S deficiencies, activated protein C resistance, antithrombin III deficiency, dysplasminogenemia, dysfibrinogenemia, and high levels of the plasminogen activator inhibitor [9]. Natarjan et al reported a case of AIDES in a patient that presented with right atrium thrombosis, and the cause of thrombosis was right heart failure [13]. In Miyata et al's study, the acquired hypercoagulable states were antiphospholipid syndrome and thrombocythemia [9], and Saxena et al showed that a severe bacterial or viral illness can cause acquired protein C deficiency [14].…”

Section: Author Contributionsmentioning

confidence: 99%

Free-floating left atrial thrombi with acquired protein C deficiency in hepatitis

Sabzi,

Faraji,

Heydarizadeh

2023

Romanian Journal of Cardiology

View full text Add to dashboard Cite

A 43-year-old woman with a recent history of confirmed hepatitis B presented with yellow sclera and dyspnea. Clinically, she had tachycardia and tachypnea as well as signs of jaundice and right upper quadrant pain. She was in sinus rhythm with a normal aspect of cardiac examination. She was treated with corticosteroids and her symptoms were partially relieved, however, her mild fever remained unchanged and a transthoracic echocardiogram (TTE) and transesophageal echocardiography (TEE) were done to rule out embolic or in situ infective endocarditis. Images from the TEE and TTE showed a ping-pong-like clot in the left atrium with a normal cardiac function and a normal mitral valve function. The mitral leaflets appeared to be normal with no regurgitation, and no clot was noted in other chambers or valves, including the atrial appendages. A differential diagnosis of infective vegetations, clots, or tumors was considered. The three subsequent blood cultures were negative. A complete thrombophilia assay revealed a severe reduced protein C factor, however, the IgG anti cardiolipin and lupus anticoagulant were normal. The woman’s anti-nuclear antibody and anti-double-stranded DNA were negative, confirming the diagnosis of acquired protein C deficiency. The patient underwent an open surgical removal of the clot and postoperative treatment with steroids, warfarin, and heparin. The postoperative course was uneventful, and the patient was discharged on the 13th day of operation in good condition. This case was interesting because we did not find any mitral valve pathology such as mitral stenosis, or arrhythmia like atrial fibrillation.

show abstract

Embolizing Massive Right Atrial Thrombus in a HIV-Infected Patient

Cited by 4 publications

References 26 publications

Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review

Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review

Case Report: Dilated cardiomyopathy with biventricular thrombus secondary to impaired coagulation in a patient with HIV

Free-floating left atrial thrombi with acquired protein C deficiency in hepatitis

Contact Info

Product

Resources

About