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      Thrombus in Transit: Extract or Dissolve?

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          Abstract

          Thrombus in transit (TIT) remains an uncommon diagnosis. However, it is often found in patients diagnosed with acute pulmonary embolism (PE). While thrombolytics are mainly used in life-threatening presentations, their role in stable patients with a known history of intracranial hemorrhage (ICH) is unclear.

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          Treatment of right heart thromboemboli.

          Peter S. Rose, Naresh M. Punjabi, David Pearse (2002)
          The presence of right heart thromboemboli complicating pulmonary thromboemboli carries with it an increased mortality rate compared to pulmonary thromboemboli alone, but little is known about the optimal management of this difficult clinical situation. This fact is highlighted in the case study of a patient with a 19-cm right atrial thrombus complicating bilateral pulmonary thromboemboli. We sought to determine the effects of anticoagulation therapy, thrombolysis, and surgical embolectomy on mortality rate in patients with right heart thromboemboli. Retrospective analysis of all reported cases in the English language literature (1966 to 2000) of right heart thromboembolism in which age, sex, therapy, and outcome were reported. We analyzed 177 cases of right heart thromboembolism. Pulmonary thromboembolism was present in 98% of the cases. The patients were evenly divided by gender with an average age of 59.8 years (SD, 16.6 years) years. Dyspnea (54.2%), chest pain (22.6%), and syncope (17.5%) were the most common presenting symptoms. The treatments administered were none (9%), anticoagulation therapy (35.0%), surgical procedure (35.6%), or thrombolytic therapy (19.8%). The overall mortality rate was 27.1%. The mortality rate associated with no therapy, anticoagulation therapy, surgical embolectomy, and thrombolysis was 100.0%, 28.6%, 23.8%, and 11.3%, respectively. Using multivariate modeling with survival as the primary outcome, age and gender were not associated with mortality rate, but thrombolytic therapy was associated with an improved survival rate (p < 0.05) when compared either to anticoagulation therapy or surgery. The presence of right heart thromboemboli may have diagnostic and therapeutic implications in pulmonary thromboembolism patients. A well-designed prospective, randomized trial is needed to determine the optimal treatment of right heart thromboemboli.
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            Hemorrhagic transformation after cerebral infarction: current concepts and challenges.

            Jie Zhang, Yi Yang, Huijie Sun … (2014)
            Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke that is especially common after thrombolytic therapy. The risk of HT limits the applicability of tissue plasminogen activator (tPA). Here, we sought to review the rate, classification, predictors, possible mechanism, and clinical outcomes of HT, as well as existing therapeutic approaches, in order to call attention to the current challenges in the treatment of this complication.
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              Mobile thrombi of the right heart in pulmonary embolism: delayed disappearance after thrombolytic treatment.

              M Baudouy, Mustapha Benhamou, E. Ferrari … (2005)
              In patients presenting with pulmonary embolism (PE), echocardiography, in some cases, reveals mobile clots in right heart (RH) cavities. How these clots evolve after treatment, in particular after thrombolytic treatment (TT), is unknown. We sought to determine the outcome of these mobile clots in the RH during TT. Of a series of 343 patients who had been hospitalized for PE in our department, echocardiography performed on hospital admittance showed a mobile clot in the RH in 18 patients (mobile clot incidence, 5.2%). This subgroup of 18 patients presented with a more severe form of PE than the 325 patients without mobile clots in the RH. In our series, 16 patients were treated with thrombolytic agents. Close echocardiography monitoring showed the outcomes of these mobile clots during and after TT. In 50% of cases, the clot disappeared rapidly in < 2 h after the end of TT. In 50% of the remaining cases, the clot disappeared later, half within 12 h following the completion of TT, and the other half within 24 h. All patients were alive on day 30 without any clinical sequellae. In these particular forms of PE with mobile clots in the RH, the short time lag required to disperse the clot after TT makes it imperative to delay any decision about new aggressive therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 4 August 2020
                Publication date (Electronic, collection): August 2020
                Volume: 12
                Issue: 8
                Electronic Location Identifier: e9550
                Affiliations
                [1 ] Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
                [2 ] Cardiology, The Mount Sinai Hospital, New York, USA
                [3 ] Internal Medicine/Cardiology, The Brooklyn Hospital Center/Mount Sinai Heart, Brooklyn, USA
                [4 ] Cardiology, The Brooklyn Hospital Center/Mount Sinai Heart, Brooklyn, USA
                Author notes
                Bolajoko O. Fayoda bfayoda@ 123456tbh.org
                Article
                DOI: 10.7759/cureus.9550
                PMC ID: 7470666
                PubMed ID: 32905490
                SO-VID: f219134e-e345-432b-99a2-a8e8efb55cfc
                Copyright © Copyright © 2020, Dhulipala et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 14 July 2020
                Date accepted : 4 August 2020
                Categories
                Subject: Cardiac/Thoracic/Vascular Surgery
                Subject: Cardiology
                Subject: Internal Medicine

                Keywords: thrombolytics,transthoracic echocardiography,pulmonary embolus,cerebrovascular accident,hemorrhagic transformation,patent foramen ovale,anticoagulation,embolectomy,right ventricle,deep vein thrombosis (dvt)
                Data availability:
                Keywords: thrombolytics, transthoracic echocardiography, pulmonary embolus, cerebrovascular accident, hemorrhagic transformation, patent foramen ovale, anticoagulation, embolectomy, right ventricle, deep vein thrombosis (dvt)

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