Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
Case Report
Thrombolytic Therapy for Acute Left Atrial Thrombus Formation in One Patient With Heart Failure and Atrial Fibrillation
Cheng-Hung LeeChun-Chi ChenMing-Shyan Chern
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2007 Volume 71 Issue 4 Pages 604-607

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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. (Circ J 2007; 71: 604 -607)

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© 2007 THE JAPANESE CIRCULATION SOCIETY
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