Intravenous thrombolysis with rtPA successfully resolved biatrial thrombosis and pulmonary embolism in a 52-year-old woman, though complicated by transient neurological symptoms.
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May support thrombolysis in select biatrial thrombi cases; hypothesis-generating and should not yet change practice.
A 52-year-old woman was admitted with the complaint of dyspnea that was present at rest and lasted a few hours. On bedside echocardiography, multiple small thrombus formations were detected in the right atrium under the tricuspid valve. Similar thrombus formation was detected in the left atrium. The lung perfusion scintigraphy indicated pulmonary embolism. Recombinant tissue plasminogen activator was started via intravenous infusion; after a dose of 60 mg, speech disturbance was observed, so thrombolytic therapy was terminated. The patient's speech problem subsided spontaneously. The dyspnea improved dramatically. Repeated bedside echocardiographic examination revealed the thrombi in both atria had disappeared.
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Görenek et al. (1998) studied this question.
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