Author + information
- Mohsen Sharifi,
- Fatemeh Larijani,
- Ryan Wycliffe,
- Beth Loggins,
- Bethany Schroeder,
- Dana De Los Monteros and
- Wilbur Freeman
Background: Large right heart thrombi are infrequently encountered in patients with pulmonary embolism (PE). There is an understandable concern that thrombolytic therapy can dislodge such clots and worsen the clinical condition by causing large PEs. We report on 28 patients who were successfully treated with low or “safe dose” thrombolysis (SDT) with tissue plasminogen activator (tPA).
Methods: We treated 28 consecutive patients with right heart thrombus (Figure) with SDT. A total of 50 mg of tPA was given:10 mg as IV bolus followed by 40 mg in 2 hours. All patients were symptomatic. Heparin was given at a modified dose. After 24 hours, the patients were switched to the maintenance dose of a new oral anticoagulant (NOAC: rivaroxaban in 12, apixaban in 13 and edoxaban in 3 patients).
Results: The most common symptoms were dyspnea and chest pain. The thrombi were relatively large. DVT was found in 21 patients. Shock was present in 8 patients. Repeat echocardiography within 30 hours of SDT demonstrated resolution of thrombi in all. All patients had an excellent response to SDT. There was no in hospital death or bleeding. The mean duration of hospitalization was 46 ± 6 hours. At a follow up of 20 ± 4 months, 25 patients (89%) were still alive. There were 3 deaths due to cancer or heart failure. There was no recurrent VTE.
Conclusions: We conclude that systemic administration of 50 mg of tPA plus a NOAC is highly safe and effective in the treatment of right heart thrombi leading to rapid resolution of symptoms and early discharge.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Vascular Medicine: Venous Disease
Abstract Category: 41. Vascular Medicine: Venous Disease
Presentation Number: 1256-362
- 2017 American College of Cardiology Foundation