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Updated: Jun 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Management of catheter-related right atrial thrombus in hemodialysis: a systematic review
Ling Chen1, Bo Chen2, Qiquan Lai1
1Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China.
Insights
Catheter-related right atrial thrombus (CRAT) in hemodialysis patients is a serious complication. Combined therapy with catheter replacement, anticoagulation, and thrombolysis is recommended for better outcomes.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Catheter-related right atrial thrombus (CRAT) is a rare but potentially fatal complication in hemodialysis patients.
- Current treatment recommendations for CRAT are not well-established, leading to varied clinical approaches.
Conclusions:
- Catheter replacement combined with anticoagulation and thrombolysis is the preferred treatment for CRAT.
- Thrombectomy should be reserved for cases where initial therapies fail or complications arise.
- Thrombolysis alone has limited efficacy but can be beneficial when used with anticoagulation.
Objective:
Hemodialysis catheter-related right atrial thrombus (CRAT) is a rare and fatal complication related with catheter. Treatment recommendations are controversial. We reported our institution's recent three cases in managing CRAT and review and analyze the reported cases of CRAT in hemodialysis patients.
Methods:
A systematic search of the PubMed, Embase and Web of Science databases was conducted to identify the therapy and outcome data in hemodialysis CRAT patients.
Results:
From 1975 to November 2023, a total of previous 144 cases which reported in the literatures and three new cases in our institution of CRAT in hemodialysis were included and analyzed. Overall mortality was 18.1% (26/144). Most of cases can be detected by echocardiography. Thirty-three patients had no treatment, except for catheter removal, replacement or antibiotics, but eleven of them have died. Thrombolytic therapy was adopted in 14 cases but only nine cases was successful, the remaining cases need to further therapy. Eventually, 71 cases have been treated by anticoagulation and 34 cases received thrombectomy.
Conclusions:
We recommend that the replacement of the catheter and anticoagulation combined with thrombolysis is a preferred therapy. Thrombectomy should be considered when other methods fail or new complication happened. Thrombolysis alone has a low success rate but may be useful in combination with anticoagulant therapy.
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