Saved by the VAC: Minimally Invasive Removal of a Surely Fatal Right Heart Thrombus in a Patient with Advanced Heart Failure

Acute pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications. Right heart thrombi deteriorate the prognosis. Due to the known high lethality, such a clinical situation requires immediate diagnosis and treatment. With the existing different management options for intracardiac blood clots, the optimal one is still uncertain. The article describes the experience of therapeutic and diagnostic tactics in a patient with PE and thrombosis of two right chambers of the heart with a favorable outcome while the conservative approach was used.

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Anticoagulant Therapy of Acute Pulmonary Embolism with Right Heart Thrombi

Авдеева

Сумин

Тяпина

et al. 2021

Vestn. anesteziol. reanimatol.

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Effectiveness of thrombolytic therapy in patients with severe COVID-19 and pulmonary embolism

Oliinyk

2024

BMBR

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Current research provides insufficient data on the use of thrombolytic therapy in the treatment of pulmonary embolism in patients with COVID-19. Existing studies present data on the efficacy of thrombolytic drug therapy for thrombotic complications in severe COVID-19. However, these studies either involve a very small number of observations or remain incomplete. This article aimed to assess systemic thrombolysis’s effectiveness in intravenous alteplase administration in this pathology. The medical records of 92 patients were analysed. Patients were divided into four groups depending on the therapy administered. Patients in the first group had complications in the form of pulmonary embolism but did not require thrombolytic therapy. Treatment of patients in the first group consisted of prescribing low-molecular-weight heparin at a therapeutic dose. Patients in the second and third groups had pulmonary embolism in the context of COVID-19 and required thrombolytic therapy. The third group differed from the second in the presence of a thrombus in the right heart. Patients in the fourth group had complications in the form of pulmonary embolism, and required thrombolytic therapy, but did not receive it due to a lack of funds. Patients in the second and third groups were immediately treated with unfractionated heparin and alteplase. Thrombolysis was not performed in the fourth group. Mortality rates were studied according to the assigned group. It was established that the risk of death increased (p<0.001) with increasing levels of D-dimer and decreased with increasing PaO2/FiO2 (p < 0.001). In the presence of a thrombus in the right heart chambers, the risk of death increased (p = 0.002), OR = 3.97 (95% CI 1.66-9.49). A trend towards reducing death risk with thrombolytic therapy was observed (p = 0.052). Data were summarised regarding the increased (p = 0.009) risk of death when thrombolytic therapy was delayed. Mortality in the fourth group was 100%. The obtained data indicate the significant effectiveness of thrombolytic therapy in the treatment of this pathology

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Saved by the VAC: Minimally Invasive Removal of a Surely Fatal Right Heart Thrombus in a Patient with Advanced Heart Failure

Cited by 2 publications

References 13 publications

Anticoagulant Therapy of Acute Pulmonary Embolism with Right Heart Thrombi

Anticoagulant Therapy of Acute Pulmonary Embolism with Right Heart Thrombi

Effectiveness of thrombolytic therapy in patients with severe COVID-19 and pulmonary embolism

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