title: Efficacy of high dose intravenous heparin for treatment of left ventricular thrombi with high embolic risk.
abstract: OBJECTIVE
  This study was performed to assess the efficacy of high dose intravenous heparin to treat mobile or protruding left ventricular thrombi as detected by serial echocardiography.
  
  
  BACKGROUND
  The presence of mobile and protruding left ventricular thrombi greatly increases the risk of arterial embolization, yet optimal therapy, be it thrombolysis, anticoagulation or surgical removal, has not been defined.
  
  
  METHODS
  Full dose heparin, 31,291 +/- 7,980 (mean +/- SD) IU/day, to prolong partial thromboplastin time to at least twice normal, was administered intravenously to 23 consecutive patients with 25 mobile and protruding thrombi. Patients were prospectively evaluated for hemorrhagic complications and embolic events during therapy. The presence or absence of thrombi and their size and characteristics were assessed by serial echocardiography.
  
  
  RESULTS
  In all 23 patients left ventricular thrombi decreased in size, with disappearance of the high risk features. The duration of high dose heparin infusion was 7 to 22 days (mean 14 +/- 4). Thrombus size was reduced from 3.9 +/- 2.6 to 0.16 +/- 0.38 cm2, and thrombus disappeared entirely in 19 (83%) of 23 patients. No embolic events were detected during treatment, and the only complication was an upper gastrointestinal hemorrhage that was successfully treated medically.
  
  
  CONCLUSIONS
  High dose intravenous heparin is a highly effective and safe treatment for completely resolving left ventricular thrombi with high risk features for embolization. Most such thrombi disappear completely within 1 to 3 weeks of this treatment without embolic or hemorrhagic complications.
authors.affiliation: Herz-Kreislauf-Klinik, Bevensen, Germany.
authors.forename: S C
authors.initials: SC
authors.lastname: Heik
authors.forename: W
authors.initials: W
authors.lastname: Kupper
authors.forename: C
authors.initials: C
authors.lastname: Hamm
authors.forename: W
authors.initials: W
authors.lastname: Bleifeld
authors.forename: D H
authors.initials: DH
authors.lastname: Koschyk
authors.forename: D
authors.initials: D
authors.lastname: Waters
authors.forename: C
authors.initials: C
authors.lastname: Chen
mesh_terms: D004452:Echocardiography; D004617:Embolism / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D006493:Heparin