Half-dose thrombolytic therapy in patients with right heart thrombi

Moosavi, Jamal; Shafe, Omid; Alizadehasl, Azin; Parsaee, Mozhgan; Sadeghpour, Anita; Khesali, Fahimeh; Pouraliakbar, Hamidreza; Kalantari, Kiara Rezaei; Farrashi, Melody; Fesharaki, Mehrdad Jafari; Sadeghipour, Parham

doi:10.1177/0300060519850399

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Interestingly, we found a half-dose (50 mg alteplase) used in a case series of five patients, with excellent outcomes. 55 There were no thrombolytic therapy-related complications in the majority of patients. In general, specific thrombolytic therapy-related complications were reported in only six patients and included intracranial hematoma, epistaxis, mild hematuria, circulatory collapse, allergic reaction to urokinase, and unspecified sudden death.…”

Section: Discussionmentioning

confidence: 84%

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Ibrahim

Ata

Choudry

et al. 2022

Clin Appl Thromb Hemost

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Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p: 0.027), chest pain ( p: 0.006), and obstructive shock ( p: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p: 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p: 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p: 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p: 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.

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Section: Discussionmentioning

confidence: 84%

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Ibrahim

Ata

Choudry

et al. 2022

Clin Appl Thromb Hemost

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“…[71][72][73] Data regarding the optimal treatment of PE with freefloating right heart thrombus seem controversial and insufficient. 74 Anticoagulation, thrombolytic therapy, surgical thrombectomy, and percutaneous catheter removal may be implemented to treat right atrial thrombus. 7, 65,72,[74][75][76][77][78][79][80] Each of these approaches has limitations and advantages.…”

Section: Management Of Patients With Right Atrial Thrombosismentioning

confidence: 99%

“…47 Prognostication and choice of antithrombotic therapy in patients with both PE and AF are understudied and may differ compared with those in isolated presentation of AF and PE. 47 In a series of five cases, Moosavi et al 74 showed the efficacy of "half-dose" or "safe-dose" thrombolytic therapy for the resolution of floating right heart thrombus. Follow-up echocardiography demonstrated complete resolution of the floating right heart thrombi and considerable improvement in the right heart function after administration of 50 mg of alteplase.…”

Section: Management Of Patients With Right Atrial Thrombosismentioning

confidence: 99%

“…Follow-up echocardiography demonstrated complete resolution of the floating right heart thrombi and considerable improvement in the right heart function after administration of 50 mg of alteplase. 74 Percutaneous vacuum-assisted thrombectomy is a valuable option for extracting right atrial thrombi. [75][76][77][78] A suction cannula allows for complete en bloc removal of the right atrial thrombus avoiding surgical procedure in high-risk patients.…”

Section: Management Of Patients With Right Atrial Thrombosismentioning

confidence: 99%

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Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

Anfinogenova

Vasiltseva

Vrublevsky

et al. 2020

Semin Thromb Hemost

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Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

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