Free-floating right heart thrombus with pulmonary embolism in SARS-CoV-2 patient

Juanola, Jordi; Rodriguez, Berta Ferreiro; Tirado, Concepció Falga

doi:10.1016/j.medcle.2020.06.025

Cited by 1 publication

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References 5 publications

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“…Carrizales-Sepúlveda et al [ 33 ] reported a case of a 62-year-old male who was diagnosed with circulatory shock and RHT on the 13th day of his COVID-19 infection; he was subsequently treated with alteplase. Another report relates to a 56-year-old male with multiple thrombi of the right atrium and right ventricle, severe dilatation of the right cavities with right ventricle overload, and significant pulmonary arterial hypertension (PAH) of 110 mm Hg, in whom thrombolysis with reteplase was performed [ 45 ]. Another 56-year-old man developed severe PAH and was diagnosed with a large free-floating thrombus in the right atrium protruding through the tricuspid valve on his 10th day of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Oliynyk,

Rorat,

Solyarik

et al. 2023

Viruses

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COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (p = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14–2.62), increased D-dimer concentration (p = 0.02, OR = 1.43 95% CI 1.06–1.93), and decreased PaO2/FiO2 ratio (p = 0.001, OR = 0.56 95% CI 0.41–0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO2/FiO2 <144 mmHg predicted a fatal outcome. The risk of death in patients with severe COVID-19 with ARDS and PE increases with higher D-dimer levels, decreased PaO2/FiO2, and delayed thrombolytic treatment. Thrombolysis seems to be treatment of choice in severe COVID-19 with PE and RHT. It should be carried out as soon as possible after the diagnosis is established.

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Section: Discussionmentioning

confidence: 99%