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Lysis of left ventricular thrombi with urokinase
Insights
Systemic thrombolysis with urokinase effectively lysed left ventricular thrombi in patients with myocardial infarction. This treatment prevented embolic events, though success varied with thrombus age and cardiac function.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Large left ventricular thrombi pose an embolic risk following myocardial infarction.
- Systemic thrombolysis is a potential treatment for these thrombi.
Purpose of the Study:
- To evaluate the efficacy and safety of systemic thrombolysis with urokinase for left ventricular thrombi in patients with recent myocardial infarction.
Main Methods:
- 16 patients with recent myocardial infarction and left ventricular thrombi received intravenous urokinase and heparin.
- Two-dimensional echocardiography was used to diagnose thrombi and assess treatment response.
Main Results:
- Successful thrombolysis was achieved in 10 of 16 patients.
- No embolic events occurred during treatment. Thrombolysis success was higher for younger thrombi (within 4 weeks).
- Left ventricular aneurysm or dysfunction reduced success rates.
Conclusions:
- Intravenous urokinase can safely lyse left ventricular thrombi.
- Further research is needed to define the risks and benefits of this therapy.
Abstract:
In 16 patients with recent myocardial infarction (3 to 12 week old) and with large left ventricular thrombi systemic thrombolysis with urokinase was performed. Left ventricular thrombi were diagnosed by two-dimensional echocardiography; in all patients the mural thrombus was located in the area of recent myocardial infarction. Each of three patients suffered an embolic episode before the initiation of thrombolytic therapy and the episode caused a stroke in one. Urokinase was infused intravenously at a rate of 60,000 U/hr for 2 to 8 days in combination with intravenous heparin (200 units/kg X 12 hr). Left ventricular thrombi were successfully lysed in 10 of 16 patients, as determined by two-dimensional echocardiography. In four of the six remaining patients only partial thrombolysis was achieved and in two thrombolytic treatment failed. There was no evidence of embolic events during thrombolysis in any of the 16 patients. The success of thrombolysis seemed to depend on the age of the thrombus: the thrombus was dissolved in eight of nine patients undergoing thrombolysis within 4 weeks of the acute myocardial infarction vs in two of seven patients receiving treatment later (p = .057). The presence of a left ventricular aneurysm or depressed left ventricular function also appeared to reduce the likelihood of successful thrombolysis. All patients were discharged on oral anticoagulants. At 6 months follow-up (n = 9) no recurrence of left ventricular thrombus was found. These results show that left ventricular thrombi can be safely lysed by intravenous urokinase. However, for better definition of the risk and benefit of this new therapy further investigation is necessary.