Treatment of intracardiac thrombi using ultra-slow low-dose thrombolytic therapy: A case report

Autores da FMUP

• Luís Alexandre De Castilho Silva Coentrão

  Autor

• Luís Filipe Vilela Pereira De Macedo

  Autor

Participantes de fora da FMUP

• Pinto, Ricardo Alves
• Torres, Sofia
• Formigo, Mariana
• Sousa, Elsa
• Neves, Aida
• Maciel, Maria Julia
• Oliveira, Teresa

Unidades de investigação

• Medicina

Abstract

A 57-year-old male with previously known severe primary mitral regurgitation was admitted to the intensive care unit (ICU) due to massive venous thromboembolism, associated with right ventricular dysfunction and two large mobile right atrial thrombi. Due to deterioration in his clinical condition despite standard treatment with unfractionated heparin, it was decided to use an ultra-slow low-dose thrombolysis protocol, which consisted of a 24-hour infusion of 24 mg of alteplase at a rate of 1 mg per hour, without initial bolus. The treatment was continued for 48 consecutive hours, with clinical improvement and resolution of the intracardiac thrombi and no complications. One month after ICU admission, successful mitral valve repair surgery was conducted. This case demonstrates that ultra-slow low-dose thrombolysis is a valid bailout treatment option in patients with large intracardiac thrombi refractory to the standard approach.(c) 2023 Published by Elsevier Espan similar to a, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Keywords

• Case report; Mitral valve insufficiency; Pulmonary embolism; Intracardiac thrombi; Thrombolytic therapy