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[Lysis treatment of left ventricular thrombi. Acute and long-term results]
D G Mathey1, V Siglow, P Kremer
1Abteilung für Kardiologie, Universitätskrankenhaus Eppendorf, Hamburg.
Insights
Intravenous thrombolysis effectively dissolved large left ventricular thrombi in most myocardial infarction patients. Long-term survival was observed, with aspirin use potentially preventing thrombus recurrence.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Context:
- Myocardial infarction (MI) frequently leads to left ventricular (LV) thrombus formation.
- Large LV thrombi pose a significant risk of systemic embolization and adverse cardiac events.
- Echocardiography is crucial for diagnosing and monitoring LV thrombi.
Purpose:
- To evaluate the efficacy and safety of intravenous urokinase thrombolysis for large LV thrombi post-MI.
- To assess the rate of thrombus lysis, complications, and long-term outcomes.
Summary:
- Fifteen patients with large LV thrombi after MI received intravenous urokinase (60,000 U/h).
- Complete lysis occurred in ten patients, partial in four; no arterial emboli were observed.
- Complications included hematuria (2) and one thrombus requiring surgery. Four patients died suddenly within six months.
- Nine patients survived up to four years without recurrence, with seven on aspirin and two on coumarins.
Impact:
- Intravenous thrombolysis is a viable option for treating large LV thrombi, potentially reducing embolic events.
- Long-term anticoagulation, particularly with aspirin, may prevent thrombus recurrence after successful lysis.
- Further research is warranted to optimize treatment strategies and improve outcomes in this high-risk patient group.
Abstract:
Intravenous thrombolysis with urokinase (60,000 U/h) was undertaken in 15 patients with large thrombi in the left ventricle (demonstrated by echocardiography) after myocardial infarction. Complete lysis was achieved in ten, partial in four. None had post-thrombolysis signs of arterial emboli, two patients developed haematuria and one had partial separation of the thrombus which required operative removal. Four patients who had a mean ejection fraction of 37 +/- 12% had died a sudden cardiac death within six months of the thrombolysis. Nine patients survived for up to four years without recurrence of thrombi: seven of them had been treated with aspirin (acetylsalicylic acid), two with coumarin derivatives. Two patients could not be followed-up. These preliminary results suggest that large left-ventricular thrombi can be successfully lysed by intravenous thrombolysis without significant complications, probably without recurrent thrombi.