Successful thrombolytic therapy for complicating large right atrial thrombus

ABSTRACT

Thrombus embolization in the right side of the heart is an unusual disease process with high morbidity and mortality and its successful management poses a challenge. A 41-year-old male, 2 weeks after bilateral ankle fracture and immobilization, developed bilateral deep venous thrombosis. A large right atrial thrombus causing right ventricular dysfunction and pulmonary embolism was responsible for his acute dyspnoea. He was haemodynamically stable. He was treated with thrombolytics and anticoagulants. The literature search for the use of thrombolytic agents in patients with right heart thrombus complicating pulmonary thromboembolism, revealed limited reports. Our patient responded well to early tissue Plasminogen activator [t-PA] therapy and follow up with anticoagulation without any bleeding or systemic complication