Regional Thrombolysis with Tenecteplase During Extracorporeal Membrane Oxygenation: A New Approach for Left Ventricular Thrombosis

Abstract

We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter.

Right Sided Intracardiac Thrombosis during Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report and Literature Review

“…Current modality used for management of ICT includes surgical thrombectomy, local thrombolysis, or usage of ventricular assist device to ensure adequate forward flow of blood to prevent new thrombus formation from stasis [12, 13]. With ICT on VA ECMO, most patients assume palliative care due to poor outcomes [14].…”

Veno-Arterial Extracorporeal Membrane Oxygenation with Conventional Anticoagulation Can Be a Best Solution for Shock Due to Massive PE

“…There are several literatures regarding the combination of V-A ECMO and thrombolysis for massive PE. 12,13) As compared to the combination of V-A ECMO and anticoagulation therapy, the combination of V-A ECMO and thrombolytic therapy should have an advantage to reduce thrombotic burden, but it would have a greater risk of bleeding complications. 14) Therefore, thrombolytic therapy should be the first line therapy for patients without any bleeding risk.…”

Successful Treatment of a Recipient With Massive Thrombosis of Heart Transplant Left Chambers During Extracorporeal Membrane Oxygenation

“…Имеется успешный опыт использования фибринолитических препара-тов на основе прямого ингибитора тромбина (бива-лирудин), рекомбинантного тканевого (альтеплаза) и модифицированного (фибринспецифического) активатора плазминогена (тенектеплаза) при воз-никновении тромбоза полостей сердца и аорты во время ВА ЭКМО [20][21][22]. Однако выполнение сис-темного тромболиза сопряжено с развитием тяже-лых геморрагических осложнений (прежде всего кровоизлияния в головной мозг), риск возникнове-ния которых у пациентов с ВА ЭКМО повышен на фоне предшествующей антикоагулянтной терапии (применение нефракционированного гепарина), тромбоцитопении, гипофибриногенемии и других расстройствах гемостаза [23]. Применение антико-агулянтов во время ЭКМО может стать причиной церебральных геморрагических осложнений, час-тота возникновения которых у отдельных категорий пациентов может составлять 13% [20].…”