2017, Number 1
Transmissible thrombus and submaximal pulmonary thromboembolism (PE) successfully treated with tenecteplase (TNK)
PDF size: 228.30 Kb.
ABSTRACTRight heart thrombus is a slightly detectable condition. In patients presenting with acute pulmonary embolism, the finding of thrombus in transit has been associated with high in-hospital mortality. We present a case of a 50-year-old male patient with acute pulmonary embolism and a thrombus in transit in the right atrium. We took the decision to perform fibrinolysis with tenecteplase, presenting significant improvement in the clinical condition, without any complications related to the therapy. Our case demonstrates the effectiveness of thrombolytic therapy in cases of pulmonary embolism and thrombus in transit in right chambers.
Konstantinides S, Torbicki A, Agnelli G, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35:3145-6.
Shamkhani W, Jafar N, Narayanan S, et al. Right heart thrombus in-transit in patient with acute pulmonary embolism treated by thrombolytic therapy with tenectplase. International Journal of Medical Imaging. 2015;3:11-5.
Pierre Justin G, Pierard LA. Management of mobile right heart thrombi: a prospective series. Int J Cardiol. 2005;99:381-8.
Romero I, Mendoca M, Cavalcanti R, et al. Right heart emboli-in-transit. Case report and literature review. Arq Bras Cardiol. 2008;90:e44-7.
Rose P, Punjabi N, Pearse D. Treatment of right heart thromboemboli. Chest. 2002;121:806-14.
Proano M, Oh JK, Frye RL, et al. Successful treatment of pulmonary embolism and associated mobile right atrial thrombus with use of a central thrombolytic infusion. Mayo Clin Proc. 1988;63:1181-5.
Bhargava M, Dincer E. Traveling thrombus in the right atrium: is it the final destination? Case Rep Pulmonol. 2012;2012:1-3.
Jammal M, Milano P, Cardenas R, et al. The diagnosis of right heart thrombus by focused cardiac ultrasound in a critically ill patient in compensated shock. Crit Ultrasound J. 2015;7:1-12.
Soga T, Sato Y, Matsumoto N, et al. Right atrial free-floating thrombus in a patient with massive pulmonary embolism: a case of ‘emboli in transit’. Int J Cardiol. 2008;129:e66-8.
Athappan G, Sengodan P, Chacko P, et al. Comparative efficacy of different modalities for treatment of right heart thrombi in transit: a pooled analysis. Vasc Med. 2015;20:131-8.
Eid G, Gaspar J, Sandoval J, et al. Combined clot fragmentation and aspiration in patients with acute pulmonary embolism. Chest. 2008;134: 54-60.
Torbicki A, Gali’e N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ. Right heart thrombi in pulmonary embolism: results from the international cooperative pulmonary embolism registry. J Am Coll Cardiol. 2003;41: 2245-51.
Chartier L, Béra J, Delomez M, et al. Free floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation. 1999;99:2779-83.
Greco F, Bisignani G, Serafini O, et al. Successful treatment of right heart thromboemboli with IV recombinant tissue-type plasminogen activator during continuous echocardiographic monitoring: a case series report. Chest. 1999;116:78-82.
Nkoke C, Faucher O, Camus L, Flork L. Free floating right heart thrombus associated with acute pulmonary embolism: an unsettled therapeutic difficulty. Case Rep Cardiol. 2015;2015:1-4.
Sharma A, Udgire PP, Khan S, Goyal BK, Gautam S. Pulmonary thromboembolism and right heart thromboemboli - an experience with tenecteplase. J Assoc Physicians India. 2012;60:52-4.
Shankarappa R, Math R, Papaiah S, et al. Free floating right atrial thrombus with massive pulmonary embolism: near catastrophic course following thrombolytic therapy. Indian Heart J. 2013;65:460-3.