Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke
<p>Abstract</p> <p>Background</p> <p>Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established treatment in acute stroke. To prevent rethrombosis after rtPA therapy, secondary anticoagulation with heparin is commonly performed. However, the rec...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2005-05-01
|
| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | http://www.cardiovascularultrasound.com/content/3/1/14 |
| _version_ | 1819044081819451392 |
|---|---|
| author | Baumann Gert Schreiber Stephan J Sanad Wasiem Doepp Florian Borges Adrian C |
| author_facet | Baumann Gert Schreiber Stephan J Sanad Wasiem Doepp Florian Borges Adrian C |
| author_sort | Baumann Gert |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established treatment in acute stroke. To prevent rethrombosis after rtPA therapy, secondary anticoagulation with heparin is commonly performed. However, the recommended time-point and extent of heparin treatment vary and are not well investigated.</p> <p>Case presentation</p> <p>We report a 61-year-old man who developed an acute global aphasia and right-sided hemiparesis. Cranial CT was normal and systemic thrombolytic therapy with tPA was started 120 minutes after symptom onset. Low-dose subcutaneous heparin treatment was initiated 24 hours later. Transthoracic echocardiography (TTE) 12 hours after admission showed slightly reduced left ventricular ejection fraction (LVEF) but was otherwise normal. 48 hours later the patient suddenly deteriorated with clinical signs of dyspnea and tachycardia. TTE revelead a large left ventricular apical thrombus as well as a reduction of LVEF to 20 %. Serial further TTE investigations demonstrated a complete resolution of the thrombus and normalisation of LVEF within two days.</p> <p>Conclusion</p> <p>Our case demonstrates an intracardiac thrombus formation following rtPA treatment of acute stroke, probably caused by secondary hypercoagulability. Rethrombosis or new thrombus formation might be an underestimated complication of rtPA therapy and potentially explain cases of secondary stroke progression.</p> |
| first_indexed | 2024-12-21T10:07:01Z |
| format | Article |
| id | doaj.art-481c5ca798084f9aaa0b05a1e0be6c6d |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-12-21T10:07:01Z |
| publishDate | 2005-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-481c5ca798084f9aaa0b05a1e0be6c6d2022-12-21T19:07:49ZengBMCCardiovascular Ultrasound1476-71202005-05-01311410.1186/1476-7120-3-14Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic strokeBaumann GertSchreiber Stephan JSanad WasiemDoepp FlorianBorges Adrian C<p>Abstract</p> <p>Background</p> <p>Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established treatment in acute stroke. To prevent rethrombosis after rtPA therapy, secondary anticoagulation with heparin is commonly performed. However, the recommended time-point and extent of heparin treatment vary and are not well investigated.</p> <p>Case presentation</p> <p>We report a 61-year-old man who developed an acute global aphasia and right-sided hemiparesis. Cranial CT was normal and systemic thrombolytic therapy with tPA was started 120 minutes after symptom onset. Low-dose subcutaneous heparin treatment was initiated 24 hours later. Transthoracic echocardiography (TTE) 12 hours after admission showed slightly reduced left ventricular ejection fraction (LVEF) but was otherwise normal. 48 hours later the patient suddenly deteriorated with clinical signs of dyspnea and tachycardia. TTE revelead a large left ventricular apical thrombus as well as a reduction of LVEF to 20 %. Serial further TTE investigations demonstrated a complete resolution of the thrombus and normalisation of LVEF within two days.</p> <p>Conclusion</p> <p>Our case demonstrates an intracardiac thrombus formation following rtPA treatment of acute stroke, probably caused by secondary hypercoagulability. Rethrombosis or new thrombus formation might be an underestimated complication of rtPA therapy and potentially explain cases of secondary stroke progression.</p>http://www.cardiovascularultrasound.com/content/3/1/14thrombolysishypercoagulabilityischemic strokecardiac thrombus |
| spellingShingle | Baumann Gert Schreiber Stephan J Sanad Wasiem Doepp Florian Borges Adrian C Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke Cardiovascular Ultrasound thrombolysis hypercoagulability ischemic stroke cardiac thrombus |
| title | Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| title_full | Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| title_fullStr | Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| title_full_unstemmed | Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| title_short | Left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| title_sort | left ventricular apical thrombus after systemic thrombolysis with recombinant tissue plasminogen activator in a patient with acute ischemic stroke |
| topic | thrombolysis hypercoagulability ischemic stroke cardiac thrombus |
| url | http://www.cardiovascularultrasound.com/content/3/1/14 |
| work_keys_str_mv | AT baumanngert leftventricularapicalthrombusaftersystemicthrombolysiswithrecombinanttissueplasminogenactivatorinapatientwithacuteischemicstroke AT schreiberstephanj leftventricularapicalthrombusaftersystemicthrombolysiswithrecombinanttissueplasminogenactivatorinapatientwithacuteischemicstroke AT sanadwasiem leftventricularapicalthrombusaftersystemicthrombolysiswithrecombinanttissueplasminogenactivatorinapatientwithacuteischemicstroke AT doeppflorian leftventricularapicalthrombusaftersystemicthrombolysiswithrecombinanttissueplasminogenactivatorinapatientwithacuteischemicstroke AT borgesadrianc leftventricularapicalthrombusaftersystemicthrombolysiswithrecombinanttissueplasminogenactivatorinapatientwithacuteischemicstroke |