Outcome of Cardiac Thrombi in Infants

Abstract

Use of central lines in the neonatal intensive care unit (NICU) has led to the formation of intracardiac thrombi. A paucity of data exists on the management of neonatal cardiac thrombi, with the few reported cases focusing on outcomes following thrombolytic therapy. This study was undertaken to evaluate the outcome of cardiac thrombi in neonates who do not receive thrombolytic therapy. Nineteen patients younger than 3 months of age diagnosed with cardiac thrombi were included. All 19 patients had a central line. Management consisted of a combination of antibiotics and low-molecular-weight heparin (n = 16) or surgical removal (n = 2). In one case, no treatment was instituted. One patient was lost to follow-up after partial resolution of the thrombus. Complete thrombus resolution occurred in 18 patients, 9 with negative blood cultures and 9 with positive blood cultures. It took longer for resolution of thrombi associated with positive blood cultures than for sterile thrombi. No patient had evidence of thrombus embolization. From these data we concluded that the natural history of cardiac thrombi is resolution. Infected thrombi require more prolonged therapy. Surgery is seldom required and thrombolytics are not usually necessary for clot resolution.

Intracardiac Thrombus in Children: The Fine Equilibrium Between the Risk and the Benefit

“…It is almost always associated with a risk factor, mostly with an indwelling catheter. The incidence of left-sided intracardiac thrombus is lower than right-sided ones, and in these patients it is almost always associated with left ventricular dysfunction or arrhythmia [2,4]. The physicians especially worry when they deal with left-sided and pedinculated thrombus because of the high risk of systemic embolization.…”

“…However, treatment of these cases has some controversies because of the potential complications, such as hemorrhage and embolization. The treatment approaches were thrombolytics [tissue plasminogen activator (t-PA), streptokinase, urokinase] and/or anticoagulants (classical/low molecular weight (LMW) heparin, warfarin) or rarely surgical thrombectomy [3,[4][5][6][7]. However, better approach or an algorithm has not yet been defined for these cases.…”

Antithrombotic Therapy in Neonates and Children

“…273,520 The epidemiology and risk associated with right atrial thrombosis appears to be different in children compared with adults. 273 The natural history appears to be resolution irrespective of therapy, and many children are asymptomatic.…”

“…Risk stratifi cation based on clot size and mobility appears to be useful. 273,520 For low-risk patients with a clot , 2 cm in size, nonmobile, and attached to the atrial wall, not pedunculated or snake shaped, then removal of the CVAD with or without anticoagulation appears appropriate. For high-risk thrombosis cases, systemic anticoagulation should be offered.…”

Reply to the correspondence letter by G. Demirel et al.

“…Other strategies for management of intracardiac thrombi include supportive care only, anticoagulant therapy with either unfractionated heparin or low molecular weight heparins, and thrombolytic therapy [2,7]. Although recombinant tissue plasminogen activator (r-tPA) has become the agent of choice for thrombolysis, the optimal dosing and duration of treatment are still unknown [7].…”