https://doi.org/10.4081/btvb.2022.44
Successful treatment of aortic arch mural thrombosis with low-dose, ultra-slow-flow thrombolysis: a case report and literature review
Submitted: 15 June 2022
Accepted: 15 September 2022
Published: 24 October 2022
Accepted: 15 September 2022
Abstract Views: 461
PDF: 160
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Aortic arch thrombosis represents a severe condition which usually requires surgical treatment in specialized centers. Treatments described in literature are mostly surgery or sodium heparin infusion. Here we describe an off-label use of alteplase in aortic arch thrombosis in a patient in whom sodium heparin treatment failed and surgery was not possible due to the site of thrombus. We report the case of a 34-year-old postpartum patient who was admitted to our hospital for aortic arch thrombosis. She had no genetic disorders for hypercoagulability, only a family history for ischemic cerebrovascular accident. As treatment with sodium heparin failed and surgery was not possible due to the site of thrombus, she received a low-dose, ultra-slow-flow treatment with alteplase for 75 hours with successful removal of the thrombus. No side effects from alteplase were observed. Considering the safety and efficacy in this patient, as well as the easiness by which it can be reproduced in the majority of clinical settings, this treatment may be a viable option in cases of aortic arch thrombosis when conventional treatments are not applicable or available.
Fayad ZY, Semaan E, Fahoum B, et al Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Ann Vasc Surg 2013;27:282-90.
DOI: https://doi.org/10.1016/j.avsg.2012.03.011
Geha AS, El-Zein C, Massad MG, et al. Surgery for aortic arch thrombosis. Thorac Cardiovasc Surg 2004;52:187-90.
DOI: https://doi.org/10.1055/s-2004-817812
Sohn V, Arthurs Z, Andersen C, Starnes B. Aortic thrombus due to essential thrombocytosis: strategies for medical and surgical management. Ann Vasc Surg 2008;22:676-80.
DOI: https://doi.org/10.1016/j.avsg.2007.12.018
Sugiura T, Dohi Y, Yamashita S, et al. A case report of asymptomatic aortic thrombosis incidentally detected by computed tomography in apparently healthy subject with a history of cancer surgery. Thromb J 2016;14:16.
DOI: https://doi.org/10.1186/s12959-016-0090-4
Poirée S, Monnier-Cholley L, Tubiana JM, Arrivé L. Acute abdominal aortic thrombosis in cancer patients. Abdom Imaging 2004;29:511-3.
DOI: https://doi.org/10.1007/s00261-003-0144-5
Fernandes DD, Louzada ML, Souza CA, Matzinger F. Acute aortic thrombosis in patients receiving cisplatin-based chemotherapy. Curr Oncol 2011;18:e97-e100.
DOI: https://doi.org/10.3747/co.v18i2.710
Laperche T, Laurian C, Roudaut R, Steg PG. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie. Circulation 1997;96:288-94.
DOI: https://doi.org/10.1161/01.CIR.96.1.288
Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005;143:697-706.
DOI: https://doi.org/10.7326/0003-4819-143-10-200511150-00006
Walker ID. Venous and arterial thrombosis during pregnancy: epidemiology. Semin Vasc Med 2003;3:25-32.
DOI: https://doi.org/10.1055/s-2003-38330
Kamel H, Roman MJ, Pitcher A, Devereux RB. Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort- Crossover Analysis. Circulation 2016;134:527-33.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.021594
Alaeddini J, Ilercil A, Shirani J. Thoraco-abdominal aortic thrombosis and superior mesenteric artery embolism. Tex Heart Inst J 2000;27:318-9.
Bohîltea RE, Turcan N, Muresian H, et al. Postpartum Aortic Bifurcation Thrombosis on the Background of Thrombophilic Disorder. Maedica (Bucur) 2016;11:241-4.
Devis P, Knuttinen MG. Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management. Cardiovasc Diagn Ther 2017;Suppl3:S309-19.
DOI: https://doi.org/10.21037/cdt.2017.10.08
Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003;29:125-30.
DOI: https://doi.org/10.1055/s-2003-38897
Voetsch B, Loscalzo J. Genetic determinants of arterial thrombosis. Arterioscler Thromb Vasc Biol 2004;24:216-29.
DOI: https://doi.org/10.1161/01.ATV.0000107402.79771.fc
Isherwood M, Serra M, Safirstein J, et al. Low-Dose Alteplase Infusion for the Treatment of Mechanical Aortic Valve Thrombosis: A Spotlight on the Importance of Medication Adherence. J Cardiovasc Nurs 2016;31:262-6.
DOI: https://doi.org/10.1097/JCN.0000000000000243
Özkan M, Çakal B, Karakoyun S, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low-dose, slow infusion of tissue-type plasminogen activator. Circulation. 2013;128:532-40.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.001145
Özkan M, Gündüz S, Gürsoy OM, et al. Ultraslow thrombolytic therapy: A novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial. Am Heart J 2015;170:409-18.
DOI: https://doi.org/10.1016/j.ahj.2015.04.025
How to Cite
Albisinni, R., Marrazzo, T., Karruli, A., Manduca, S., Nobile, G., Galdieri, N., & De Feo, M. (2022). Successful treatment of aortic arch mural thrombosis with low-dose, ultra-slow-flow thrombolysis: a case report and literature review. Bleeding, Thrombosis and Vascular Biology, 1(3). https://doi.org/10.4081/btvb.2022.44
Copyright (c) 2022 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Roberto Mario Santi, Annamaria Fulghesu, Ezio Zanon, Erica De Candia, Elvira Grandone, Giancarlo Di Renzo, Claudia Succu, Valentina Tosto, Vincenzina Bruni, Paolo Gresele, Diagnosis and management of abnormal uterine bleeding in adolescence , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 1 (2024)
- Silvia Cardi, Filippo Catalani, Luca Valerio, Stefano Barco, From rare to aware: confronting Lemierre syndrome , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 3 (2024)
- Matteo Guarascio, Gerardo Nicola Pititto, Alessia Abenante, Marco Paolo Donadini, Distal deep vein thrombosis: is there a way out of this dark forest? , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
- Mattia Galli, C. Michael Gibson, Dominick J. Angiolillo, Factor XI inhibitors in adjunct to antiplatelet therapy: the ultimate dual-pathway inhibition? , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Daniela Poli, Emilia Antonucci, Gualtiero Palareti, Roberto Facchinetti, Pietro Falco, Giuseppina Serricchio, Teresa Lerede, Lucilla Masciocco, Paolo Gresele, Sophie Testa, Major bleedings in mechanical prosthetic heart valves patients on Vitamin K antagonist treatment. Data from the PLECTRUM Study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Luca Puccetti, Vincenzo Sammartano, Federico Caroni, Margherita Malchiodi, Paola Calzoni, Eleonora Franceschini, Lucrezia Galasso, Monica Bocchia, Safety of COVID-19 mRNA vaccination in patients with history of acquired hemophilia A: a case series , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Boris Shenkman, Ivan Budnik, Yulia Einav, Interaction between adenosine diphosphate receptors and protein-kinase C isoforms in platelet adhesion under flow condition , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Agnes Y.Y. Lee, Venous thromboembolism treatment in patients with cancer: reflections on an evolving landscape , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024): 12th ICTHIC
- Simon Noble, Patient and public involvement in cancer-associated thrombosis research: necessary or glorified tokenism? , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024): 12th ICTHIC
- Rushad Patell, Jeffrey I. Zwicker, Rohan Singh, Simon Mantha, Machine learning in cancer-associated thrombosis: hype or hope in untangling the clot , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024): 12th ICTHIC
You may also start an advanced similarity search for this article.
