Acute thrombotic left main coronary artery; treatment with low dose slow infusion tPA

Akçay, Murat; Soylu, Korhan; Yanık, Ahmet

doi:10.1016/j.ijcard.2016.09.013

Cited by 4 publications

(5 citation statements)

References 2 publications

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“…A slow infusion (8 h) low dose (50 mg) t-PA regimen was successful in complete lysis of a mobile left ventricular thrombus within 24 h [ 18 ]. Administering of 25 mg rt-PA in 6 h was shown to be effective in lysis of thrombi in a patient with free-floating right atrium thrombus and in another patient with acute thrombotic left main coronary artery [ 19 , 20 ]. Further, a study consists of 12 patients with thromboembolic events performed the slow infusion method of t-PA and revealed promising data regarding its safety and efficacy [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature

2023

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The hyper-coagulopathy nature of COVID-19 is a prevalent consequence among patients. Free-floating right atrial thrombi are a relatively rare finding and the optimal therapy is a therapeutic dilemma.We present a 37-year-old woman with acute dyspnea and fatigue. Several ground glass opacities were shown on computed tomography of chest that further proved to be associated with severe COVID-19 disease. A transthoracic echocardiography revealed a mobile right atrial mass with bilateral pulmonary embolism. She was considered high risk for surgical therapy by cardiovascular surgeons. She was then started on anticoagulation therapy for 5 days however the size regression of the thrombus remained unchanged. A regimen of low dose (24 mg) ultra-slow (24 h) intravenous infusion of alteplase, without bolus was initiated. Following the third day of thrombolytic therapy, the control echocardiography demonstrated complete resolution of the thrombus.Prolonged infusion of low dose fibrinolytics can be an alternative treatment to surgery for right heart thrombi.

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Section: Discussionmentioning

confidence: 99%

Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature

2023

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“…There are many different treatments available in the literature on isolated thrombotic non-NSTEMI patients that allow coronary flow. However, Akcay et al 3 reported successful treatment with 25 mg tPA infusion for 6 hours in a case which was refractory to anticoagulant and antiaggregant therapies that allow coronary flow.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Thrombotic coronary artery occlusions, especially in the left main coronary artery (LMCA) or left anterior descending (LAD) artery thrombosis, usually present with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias, or sudden cardiac death. 1 - 3 Within the context of atherosclerotic risk factors, the usual cause of coronary artery thrombotic occlusions is atherosclerotic process resulting from plaque rupture and release of thrombogenic components from plaque with subsequent thrombus formation. 2 Despite the absence of atherosclerosis, some cases of spontaneous coronary thrombus formation have been described, especially in younger patients.…”

Section: Introductionmentioning

confidence: 99%

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Low-Dose Slow Infusion Tissue Plasminogen Activator (tPA) in Treatment of Thrombotic Coronary Artery Occlusions: Case Series and Literature Review

Akçay

Çoksevim

Yildirim

et al. 2022

Anatolian J Cardiol

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Thrombotic coronary artery occlusions usually manifest as acute coronary syndrome with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias, or sudden cardiac death. Although it usually occurs based on atherosclerosis, it can also occur without atherosclerosis. There is no predictor of coronary artery thrombosis clinically and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting, entrapment of thrombus in vessel wall with stent implantation, intracoronary thrombolysis, glycoprotein IIb/IIIa inhibitors, anticoagulation with heparin, and thrombus aspiration as reperfusion strategies. Here, we reviewed a new treatment strategy based on the literature, and a case series with successful results in hemodynamically stable patients with low-dose slow infusion tissue plasminogen activator (tPA) for thrombotic coronary artery occlusions that allow coronary flow was reported. Prospective randomized studies and common consensus are needed on low-dose, slow-infusion tissue plasminogen activator treatment regimen and optimal treatment management for thrombotic coronary artery occlusions.

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“…Karakoyun et al 16 have reported prosthetic valve thrombosis (PVT) complicated with coronary embolism which were successfully treated with low dose, slow infusion intravenous tPA. Again Akcay et al 17 reported successfully treatment with 25 mg tPA intravenous infusion for 6 h in a case which was refractory to antiaggregan treatment and resulted from atherosclerotic plaque rupture. As shown this case, low dose, slow infusion tPA regime may be new treatment approach for thrombotic LMCA occlusions that allow coronary flow and on hemodynamically stable patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of thrombotic left main coronary artery occlusions; old problem, different treatment approaches

Akçay

2018

Indian Heart Journal

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Thrombotic left main coronary artery (LMCA) occlusions usually manifest as acute coronary syndrome (ACS) with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias or sudden cardiac death. There is no clinically predictor for LMCA thrombosis and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting (CABG), stent implantation, intracoronary thrombolysis, anticoagulation with heparin or glycoprotein IIb/IIIa inhibitors, thrombus aspiration as reperfusion strategies. Recently, successful results have been reported with low dose, slow infusion tPA for treatment of LMCA thrombus that allowing coronary flow. This regime may be a new treatment idea in only hemodynamically stable patients. Prospective studies and common consensus are needed about the low dose, slow infusion tPA treatment regime and optimal treatment for thrombotic LMCA obstructions.

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Acute thrombotic left main coronary artery; treatment with low dose slow infusion tPA

Cited by 4 publications

References 2 publications

Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature

Low dose ultra-slow infusion thrombolytic therapy (LDUSITT) as an alternative option in a COVID-19 patient with free-floating right atrial thrombus: a case report and review of literature

Low-Dose Slow Infusion Tissue Plasminogen Activator (tPA) in Treatment of Thrombotic Coronary Artery Occlusions: Case Series and Literature Review

Evaluation of thrombotic left main coronary artery occlusions; old problem, different treatment approaches

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