Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism

Cracowski, Jean‐Luc; Tremel, F; Baguet, Jean-Philippe; Mallion, Jean-Michel

doi:10.1002/clc.4960220222

Cited by 16 publications

(12 citation statements)

References 14 publications

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“…Studies showed that immediate thrombolytic therapy can resolve thrombi within 2 to 72 hours and normalize right ventricle function. 8,9,18 In our case, 4 out of 6 patients received streptokinase followed by heparin infusion. Two patients had contraindications for thrombolytic therapy and they received heparin infusion only.…”

Section: Discussionmentioning

confidence: 79%

The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

et al. 2008

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Section: Discussionmentioning

confidence: 79%

The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

et al. 2008

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“…The effect of thrombolytic therapy on mortality is controversial. There are favorable results of thrombolytic therapy over heparin in patients with RHT associated PE in a small case series (10,13,(16)(17)(18)(19). First meta-analysis including 119 patients with RHT showed similar efficacy of all three treatment options (8).…”

Section: Discussionmentioning

confidence: 98%

Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience

Akıllı

Gül²,

Arıbaş³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients. (Anadolu Kardiyol Derg 2013; 13: 528-33) Key words: Right heart thrombus, pulmonary embolism, thrombolysis, mortality Original Investigation Özgün Araşt›rma 528ÖZET Amaç: Pulmoner emboli (PE) ile ilişkili sağ kalp trombüslerinin mortalitesi 3-4 kat artmaktadır. En korkulan senaryo ise sağ kalp trombüslerinin parçalanması sonucunda rekürren pulmoner emboli gelişmesidir. Pulmoner embolilere eşlik eden sağ kalp trombüsü vakalarının tedavisi zordur ve bu konu ile ilgili literatürde yeterli veri bulunmamaktadır. Yöntemler: Ocak 2006 ila Aralık 2011 tarihleri arasında akut pulmoner emboli tanısı almış 312 hastanın verileri retrospektif olarak incelendi. Bilgisayarlı tomografi ile tanı almış 312 akut PE hastalarından ekokardiyografide sağ kalp trombüsü bulunan 35 hasta çalışmaya alındı. Metastatik malignansi bulunan 6 hasta çalışmadan dışlandı. Yirmi dokuz hasta değerlendirilme için uygun bulundu. Hastaların ekokardiyografik raporları da incelendi. Ayrıca katetere bağlı gelişen trombüs (tip B) vakaları da çalışmaya dahil edilmedi. Kategorik değişkenlerin karşılaştırılmasında Ki-kare ve non-parametrik sürekli de...

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“…In the event of mobile multiple intra-cardiac thrombi, surgery might not be a good choice for their complete removal. In these conditions, thrombolytic therapy might be preferable [8]. …”

Section: Discussionmentioning

confidence: 99%