Successful Treatment of Right Ventricular Thrombus with Heparin and Sodium Warfarin Therapy: A Case Report
AbstractA 75-year-old woman came to our emergency clinic complaining of abdominal pain. Acute cholecystitis was diagnosed, and parenteral antibiotic therapy was initiated. Because of palpitation, she had a consultation with the cardiology clinic. Echocardiography showed a 2.7 x 2.2 cm mobile thrombus attached to the apex of the right ventricle. Since no thromboembolic complications were present, we decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. The patient received low-molecular weight heparin in addition to sodium warfarin for 5 days. Administration of heparin was then stopped and treatment was continued with sodium warfarin. In the series of weekly echocardiography evaluations, a gradual reduction was noted in the apical mass, which was initially considered to be a thrombus, and 3 weeks later evaluation revealed that the thrombus in the right ventricle had disappeared completely. No thromboembolic complications were observed during the follow-up period.
Baykan M, Celik S, Erdol C, et al. 2001. Behcet's disease with a large intracardiac thrombus: a case report. Heart 85:e7.nCalvo JR, Duran RM, Vazquez de Prada JA. 1990. Resolution of relapsing thrombus by heparin therapy in right ventricular dysplasia. Int J Cardiol 26: 238-9.nChartier L, Bera J, Delomez M, et al. 1999. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 99:2779-83.nDoireau V, Daoud P, Pasche J, Le Bidois J. 1993. Right intraventricular thrombus. Rare complication of caval catheterization. Arch Fr Pediatr 50:887-9.nSchneider C, Bahlmann E, Heuser C, et al. 2003. Images in cardiovascular medicine. Unusual biventricular thrombus formation in acute myeloid leukemia and factor V leiden mutation. Circulation 107:e114-6.nTask Force on Pulmonary Embolism, European Society of Cardiology. 2000. Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J21:1301-36.nTorbicki A, Galie N, Covezzoli A, Rossi E, Rosa MD, Goldhaber SZ. 2003. Right heart thrombi in pulmonary embolism—results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 41:2245-51.nYeh KH, Hung KC, Lin FC, Yeh SJ, Wu D. 2000. Successful lysis of right and left heart thrombus by tissue plasminogen activator. Catheter Cardiovasc Interv 49:91-6.n