Successful Lysis of Intra-Cardiac Thrombi with Streptokinase in Patients with Renal Failure; Two Case Reports and Review of the Literature

Abstract

In situ formation of thrombi within the cardiac cavities carries a substantial risk of morbidity and mortality due to the inherent danger of embolization to vital organs. This typically occurs in patients with underlying cardiac disorders associated with low flow state favoring regional stagnation of blood and subsequent clotting. Occasionally, extra-cardiac conditions such as renal failure predispose to the development of intra-cardiac thrombi in the presence or absence of identifiable cardiac abnormalities. Once identified, the appropriate treatment of such thrombi remains highly controversial. Here, we report on the successful and safe use of streptokinase in two patients with end stage renal disease with high risk left ventricular, right ventricular and right atrial thrombi.

Thrombolytic Therapy for Acute Left Atrial Thrombus Formation in One Patient With Heart Failure and Atrial Fibrillation

“…12 Thrombolytic therapy is another option for treating an LA thrombus. 3 In this case, thrombolysis for this 2.6×1.4 cm thrombus was quick and complete. During the administration of thrombolytics, the patient only experienced minor gum bleeding and no embolism resulted from shedding fragments.…”

“…The prompt management options may include administration of anticoagulants, thrombolytics and surgery. [2][3][4] In certain cases, decision making may sometimes be difficult and several issues should be considered.…”

“…1 Although anticoagulants, thrombolytics and surgery have been utilized in managing acute LA thrombi, a standard treatment protocol is not available yet. [2][3][4] For most physicians, the principal factors in determining treatment modality are the size, shape and mobility of the thrombus. This report presents a patient with heart failure and atrial fibrillation in whom thombolytic therapy was administered for her new large, elongated mobile thrombus in the LA.…”

Rheumatic Giant Left Atrium—An Overview

“…Rhythm changes (atrial fibrillation or atrial flutter) Thrombolytic therapy is another option for treating the LA thrombus [79] and shown to be effective in patients with mitral prosthesis with thrombosis [80]. The effectiveness and risk of thrombolytics for an organized or partially organized thrombus or thrombi of long duration is not known clinically.…”

Three-dimensional echocardiography in the diagnosis of fast-moving intracardiac formations

“…Například současná práce zmiňuje výhody ponechané TEE-sondy při farmakologické léčbě intrakardiální trombózy. (23) Z praktického hlediska stojí za zdůraznění potvrzení operačního řešení, jako léčby první volby u třetího, zcela asymptomatického pacienta (extirpace následně verifikovaného myxomu). Rovněž zvažované podání systémové trombolýzy na předpokládanou trombotickou etiologii útvaru samotný pacient zprvu jednoznačně upřednostňoval před chirurgickým řešením.…”