Thrombolytic therapy for acute left atrial thrombus formation in one patient with heart failure and atrial fibrillation.

Abstract

Patients with a left atrial (LA) thrombus are considered at high risk of thromboembolic events. Reports about thrombolytic therapy are limited and optimal guidelines are lacking. In this report, a large, pedunculated, highly mobile thrombus of the LA attached via a short stalk to the LA appendage brim in a 59-year-old female with atrial fibrillation is described. The patient was treated with 100 mg intravenous tissue plasminogen activator for 2 h after the ineffective administration of herapin. The thrombus soon dissolved. However, the patient developed a transient ischemic embolism 12 h later when the post hoc heparin effect was at its nadir. Based on this and other reports, thrombolytic therapy may be effective and safe in patients with acute, non-organized LA thrombi and post hoc heparinization should be sufficient to prevent thromboembolism from rebound coagulation.

• Authors: Cheng-Hung Lee, Chun-Chi Chen, Ming-Shyan Chern
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 71 Issue 4 Pg. 604-7 (Apr 2007) ISSN: 1346-9843 [Print] Japan
• PMID: 17384466 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Anticoagulants
• Heparin

Topics

• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications)
• Cardiac Output, Low (complications)
• Echocardiography
• Female
• Heart Atria (diagnostic imaging)
• Heparin (therapeutic use)
• Humans
• Middle Aged
• Thrombolytic Therapy (methods)
• Thrombosis (drug therapy, etiology)