Key result
Sequential enoxaparin and apixaban resolves right atrial thrombus and restores RV function within ~10 days.
Why the study?
Right heart thrombi are rare, potentially life-threatening complications of acute pulmonary embolism, and their optimal management remains controversial.
Does therapeutic anticoagulation alone with enoxaparin followed by apixaban resolve right atrial thrombus in transit and improve right ventricular function in a hemodynamically stable patient with intermediate-high-risk pulmonary embolism?
Case Report (n=1)
No
Does therapeutic anticoagulation alone with enoxaparin followed by apixaban resolve right atrial thrombus in transit and improve right ventricular function in a hemodynamically stable patient with intermediate-high-risk pulmonary embolism?
This case report demonstrates that therapeutic anticoagulation alone with enoxaparin followed by apixaban can achieve complete resolution of a free-floating right atrial thrombus and right ventricular recovery within 10 days in a carefully monitored, hemodynamically stable patient with intermediate-high-risk pulmonary embolism.
Supports medical management in select stable patients with right atrial thrombus and pulmonary embolism; leaves open need for randomized data before broader adoption.
Right heart thrombi are rare but potentially life-threatening complications of acute pulmonary embolism. We report the case of a 57-year-old hemodynamically stable woman with pulmonary embolism and a large free-floating right atrial thrombus associated with right ventricular dilatation and systolic dysfunction. Anticoagulation with enoxaparin followed by apixaban led to complete thrombus resolution within 10 days, with regression of right ventricular dilatation and recovery of systolic function. This case suggests that anticoagulation alone may be effective in carefully selected hemodynamically stable patients, although the optimal management of right heart thrombi remains controversial. Early echocardiographic diagnosis and individualized treatment are essential.
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YASSER et al. (2026) conducted a case report in Acute intermediate-high-risk pulmonary embolism complicated by a free-floating serpiginous right atrial thrombus in transit and left popliteal deep vein thrombosis (n=1). Enoxaparin followed by apixaban was evaluated on Complete resolution of right atrial thrombus and recovery of right ventricular systolic function. Anticoagulation with enoxaparin followed by apixaban resulted in complete right atrial thrombus resolution and right ventricular recovery within 10 days in a stable patient with pulmonary embolism.
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