Treatment of pacemaker-associated right atrial thrombus with 2-hour rTPA infusion

Prolonged low‐dose thrombolytic therapy: A novel adjunctive strategy in the management of an infected right atrial thrombus

“…Cooper et al successfully treated a noninfected, pacemaker lead-associated right atrial clot with a 2-h, highdose t-PA infusion. 5 However, the thrombus size in their patient (2 ϫ 1.6 cm) was considerably smaller than that of our patient. Therefore, we reasoned that a prolonged, low-dose thrombolytic infusion would yield a better clinical result.…”

Role of Cardiac Ultrasound in the Detection of Pulmonary Embolism

“…Early mortality (at 8 days) is approximately 9% in these patients, and thus much lower than the mortality of patients with free-floating type A thrombi. 57 Successful treatment of thrombi attached to pacemaker electrodes by infusion of recombinant tissuetype plasminogen activator has been reported, 77,78 but conventional intravenous or oral anticoagulation is likely to be adequate for the majority of patients with type B right heart thrombi.…”

An Unusual Case of Multiple Right Atrial Thrombi in a Patient with a Dual-Chamber Pacemaker

“…7 Several therapeutic options are available for patients with pacemaker-wire-associated right atrial thrombosis: (1) anticoagulation with heparin followed by chronic warfarin therapy, (2) surgical removal of pacemaker lead followed by anticoagulation, and (3) thrombolysis followed by anticoagulation.8-1° Our patient refused surgical intervention, and thrombolysis was not recommended because of a recent stroke. The long-term residence of permanent pacemaker leads may act as a continuous nidus for the formation of thrombus.3 Multiple pacemaker wires increase the total surface area of foreign material at risk for thrombus formation.4 Pacemaker leads may produce a foreign-body-type reaction with subsequent inflammation and fibrosis along the course of the wire, and this may lead to thrombus propagation along the pacing lead.3 The following factors are known to predispose to pacemaker-lead-associated thrombosis: congestive heart failure, hypercoagulable states (such as antithrombin III, proteins C and S deficiencies, cancer, etc), and possibly pacemaker lead material itself.…”