Right atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithm

Abstract

We propose a management algorithm emphasizing the removal of the catheter and recommending anticoagulation as first-line treatment. Surgical thrombectomy is valuable when other treatments fail or in special circumstances. Thrombolysis has a poor success rate but may be useful in pulmonary embolism.

Right atrial mass in a 23-year-old woman with molar pregnancy

“…8 Evidence from small observational studies recommends considering fibrinolytic therapy in the setting of catheter-related thrombi with pulmonary embolism. 9 However, our patient did not fit these clinical profiles. Given the high risk of bleeding with the uterine malignant growth, fibrinolytic therapy was ruled out.…”

American Society of Nephrology Quiz and Questionnaire 2013

“…Whereas catheter-associated bloodstream infections were most frequent (5.1 per 1000 catheter-days), thrombotic complications were the second most common (0.80 per 1000 catheter-days) (21). Thrombotic complications with central venous catheters include a fibrin sheath, an intraluminal clot, mural thrombosis, catheter-associated venous thrombosis (or secondary deep venous thrombosis as in this patient), or catheter-associated right atrial thrombus (22,23).…”

The Dilemma in Treatment of hemodialysis patients with catheter-induced right atrial thrombi (CRAT): A case report

“…Incidence rate for CRAT is 2-29% [2]. The overall mortality rate associated with CRAT has been reported to be 18.3% in hemodialysis patients, (depending on the presence of complications and on non-removal of hemodialysis catheter) and over 40% in non-hemodialysis patients [3]. According to European working group on echocardiography, there are three types of right atrial thrombi [4].…”

“…The management of right atrial thrombi is a matter of debate among cardiologists. Anticoagulation, surgical removal, thrombolysis and percutaneous intravascular removal of the thrombus are current treatment options [3]. In a meta-analysis that included 71 cases of CRAT in dialysis patients Stavroulopoulos et al [3] compared current options for management of CRAT.…”

“…Anticoagulation, surgical removal, thrombolysis and percutaneous intravascular removal of the thrombus are current treatment options [3]. In a meta-analysis that included 71 cases of CRAT in dialysis patients Stavroulopoulos et al [3] compared current options for management of CRAT. They suggested removal of catheter and anticoagulation as first-line treatment and administration of antibiotics in any cases of bacteremia.…”