Use of temporary vena cava filters after catheter-directed fragmentation and thrombolysis in patients with acute pulmonary thromboembolism

Recurrence of idiopathic thromboembolism during anticoagulant therapy

Patients with acute pulmonary embolism and venous thromboembolism are usually treated with anticoagulant therapy for at least 3 months as the optimum duration. A patient with recurrent idiopathic venous thromboembolism at the eighth month during anticoagulation (warfarin to target international normalized ratio of 2.0-3.0) is described. The case suggests that patients with idiopathic venous thromboembolism have a high risk of recurrence, even if a strict anticoagulant regimen is followed.

Thrombolytic therapy for venous thromboembolism

The role of thrombolytic therapy for venous thromboembolism remains uncertain. To date, no well-designed randomized clinical trial has shown that the benefits of thrombolysis exceed the risks for a well-defined subgroup of patients with acute pulmonary embolism. Recent reports have underscored the risks of thrombolytic therapy. The largest multinational registry of patients in whom acute pulmonary embolism had been diagnosed found that 3% of 311 patients who underwent thrombolysis for acute pulmonary embolism suffered an intracranial hemorrhage. Because of the serious risk associated with systemic thrombolysis, investigators have continued to study methods that rapidly remove venous thromboemboli while minimizing the risk. Reports of catheter fragmentation combined with thrombolysis as well as catheter-directed thrombolysis are promising, but well-designed clinical trials are needed to clarify the utility of these techniques.

A chronic, massive thrombus in the right main pulmonary artery: a case report and echocardiographic analysis

A chronic, large thrombus in the right main pulmonary artery (PA) was detected in a 54-year-old woman with a history of surgical repair of atrial septal defect. Color flow imaging revealed a prominent red signal along the right border of the markedly dilated PA. Pulsed Doppler echocardiography showed that the red signal was caused by flow reversal occurring during systole. According to the physics of blood flow, flow reversal probably represents secondary, helical flow, which may be related to thrombus formation.