Thrombolytic therapy for acute left atrial thrombus formation in one patient with heart failure and atrial fibrillation.
Patients with a left atrial (LA) thrombus are considered at high risk of thromboembolic events. Reports about thrombolytic therapy are limited and optimal guidelines are lacking. In this report, a large, pedunculated, highly mobile thrombus of the LA attached via a short stalk to the LA appendage brim in a 59-year-old female with atrial fibrillation is described. The patient was treated with 100 mg intravenous tissue plasminogen activator for 2 h after the ineffective administration of herapin. The thrombus soon dissolved. However, the patient developed a transient ischemic embolism 12 h later when the post hoc heparin effect was at its nadir. Based on this and other reports, thrombolytic therapy may be effective and safe in patients with acute, non-organized LA thrombi and post hoc heparinization should be sufficient to prevent thromboembolism from rebound coagulation.
Lee
Cheng-Hung
CH
Second Section of Cardiology, Medical Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.
Chen
Chun-Chi
CC
Chern
Ming-Shyan
MS
D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002303:Cardiac Output, Low / Q000150:complications*; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*
D000925:Anticoagulants; D006493:Heparin