Massive chronic atrial thrombosis

Maria Angela Losi1, Paolo Golino, Sandro Betocchi

  • 1Department of Clinical Medicine and Cardiovascular and Immunological Sciences, Federico II University-School of Medicine, Via Pansini 5, 80131 Naples, Italy. losi@unina.it

Insights

Large left atrial thrombi, previously thought resistant to treatment, can completely resolve with long-term anticoagulant therapy including warfarin and aspirin. Transesophageal echocardiography confirmed thrombus dissolution without clinical embolism.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Left atrial thrombosis poses a significant risk of embolic events.
  • Large and organized thrombi are often considered resistant to anticoagulant therapy.

Observation:

  • A patient presented with a large, old left atrial thrombus detected via transesophageal echocardiography.
  • The patient was treated with warfarin and aspirin for two years.

Findings:

  • Transesophageal echocardiography revealed complete resolution of the left atrial thrombus.
  • No clinical evidence of embolism was observed during or after therapy.

Implications:

  • This case suggests that even large, organized thrombi may be susceptible to dissolution with prolonged anticoagulant treatment.
  • Transesophageal echocardiography is crucial for monitoring left atrial thrombus resolution and understanding warfarin's efficacy.
  • Further research into the lytic potential of anticoagulants like warfarin in complex thrombotic scenarios is warranted.

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