Urokinase therapy for a catheter-related right atrial thrombus

Neonatal and childhood right atrial thrombosis: recognition and a risk-stratified treatment approach

“…Figure 2 [2] Case report 1 Road traffic accident victim on TPN Korones et al [13] Prospective cohort 13 Cancer Marsh et al [14] Prospective 1 Prematurity, bowel perforation on TPN Bilginer et al [15] Case report 1 Renal transplant Torres-Validvesso et al [16] Case report 1 Prematurity Giuffrè et al [17] Case report 2 Prematurity Giannoulia-Karadana et al [18] Case report 2 Wilms tumor Dollery et al [19] Retrospective 5 Gut failure on TPN Asante-Korang et al [20] Case report 1 Tricuspid atresis, post-Fontan procedure Ross et al [21] Retrospective 16 Prematurity and cancer Sharrat et al [22] Case reports 1 Post-Fontan procedure Ozimek et al [23] Case report 1 Non-Hodgkins lymphoma De Schepper et al [24] Case reports 2 Prematurity, on TPN Hollingsed et al [25] Case report 1 Sickle cell anemia, fungal septicemia Riggs et al [26] Case reports 4 Prematurity, TPN, Wilms tumor Ká dá r et al [27] Case report 6 Postcardiac surgery Delaplane et al [28] Case report 1 Prematurity, on TPN Marsh et al [29] Case reports 2 Prematurity, septicemia Mahony et al [30] Case reports 2 Gastroschisis, TPN, and liver tumor Graham and Gumbiner [31] Case report 1 Prematurity, gastroschisis Sadiq et al [32] Case series 10 Prematurity and TPN Cesaro et al [33] Case report 1 Non-Hodgkins lymphoma Kingdon et al [34] Case reports 2 Renal failure on dialysis Paut et al [35] Case report 1 Trauma on TPN Moukarzel et al [36] Retrospective 6 All on TPN Teitelbaum et al [37] Case report 1 Failure to thrive, vomiting, on TPN RAT, right atrial thrombosis; TPN, total parenteral nutrition. …”

Fungal endocarditis

“…Plasmin, in turn, digests fibrin. 7 Urokinase can indiscriminately dissolve not only pathologic thrombi but hemostatic clots as well and thereby may lead to serious hemorrhagic complication. Therefore, close monitoring of coagulation profile is extremely important.…”

Echocardiographic Detection of Intracardiac Thrombi Complicating Ventriculo-Atrial Shunt

“…It con sisted of a median sternotomy under circulatory arrest, extracorporeal circulation, auriculostomy, embolectomy, and valvular reparation as needed. After that procedure, the shunting device must be replaced at an extravascular site, if possible [31], The surgical mortality associated with this aggressive treatment varies between 21 and 67% [5,9,17,20,29], but seems to be more around 25%. Bouvier et al [ 18] stated that if the thrombus is free-floating in the cardiac chambers, the treatment has to be surgery.…”

“…However, most authors agree that if patients present signs or symptoms of cor pulmonale, the mortality will be 100%, no matter which type of treatment is applied [2,5,7], It has been estimated that, when there is pulmonary' hypertension, at least 60% of the pulmonary vasculariza tion is already obstructed [31], If the thrombus is evac uated before the beginning of a cor pulmonale, we can hope to reverse the progression of pulmonary hyperten sion [5] emphasizing the importance of prophylactic ap proaches.…”