The Successful Use of Low-Dose Recombinant Tissue Plasminogen Activator for Treatment of Intracardiac/Pulmonary Thrombosis During Liver Transplantation

Abstract

Intracardiac thrombosis and pulmonary embolism are uncommon complications during liver transplantation but carry a high mortality rate. We report the successful use of low-dose recombinant tissue plasminogen activator (0.5-4 mg) administration in 4 patients. Early diagnosis through transesophageal echocardiography and pulmonary artery catheterization may have contributed to the rapid thrombolysis.

Emergent Management of Intracardiac Thrombosis during Liver Transplantation

“…In their report, the clots were significantly reduced in size or disappeared within 1 to 3 weeks without complications [13]. Boone et al reported a case series of four patients where they used low dose rTPA (0.5 mg–4 mg) to treat intracardiac and pulmonary thrombosis during OLT [3]. In each of these cases, patients were hemodynamically unstable and in different stages of surgery.…”

“…Intracardiac thrombus (ICT) formation during orthotopic liver transplantation (OLT) is associated with a mortality rate as high as 68% [2]. A small number of published reports describe the successful use of recombinant tissue plasminogen activator (rTPA) as well as thrombectomy in the treatment of both intracardiac and pulmonary thrombi [3]. There are some reports of the use of intravenous heparin for the treatment of ICT during OLT in hemodynamically unstable patients [3].…”

“…A small number of published reports describe the successful use of recombinant tissue plasminogen activator (rTPA) as well as thrombectomy in the treatment of both intracardiac and pulmonary thrombi [3]. There are some reports of the use of intravenous heparin for the treatment of ICT during OLT in hemodynamically unstable patients [3]. All of these attempts failed.…”

Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation

“…7,8 Other reports of successful resuscitation with adjuncts such as anticoagulants, thrombolytics, and ECMO have been described as well. 3,7,9,10 Herein, we report the case of a patient presenting for OLT who experienced prolonged post reperfusion cardiac arrest with intracardiac thrombus formation. Spontaneous circulation ensued after 51 minutes of resuscitative efforts.…”

Intestinal transplantation: The anesthesia perspective

“…Recombinant tissue plasminogen activator (rTPA) is used to manage acute pulmonary thromboembolism with hemodynamic decompensation. The doses used are 40 to 100 mg over 2 h. Even at low doses, the risk of hemorrhage persists [71][72][73].…”