CLINICAL EXPERIENCE OF COMPREHENSIVE TREATMENT OF VENOUS THROMBOSIS WITH CARDIOPULMONARY COMPLICATIONS (case report)
Keywords:
venous thrombosis, pulmonary embolism, intracardiac thrombus, intensive anticoagulation therapy, thrombolytic therapy, echocardiography, duplex scanning, multidisciplinary approach.Abstract
Background. Venous thromboembolic complications remain one of the leading causes of cardiovascular mortality. Distal deep vein thromboses are characterized by high embolic potential, with massive pulmonary embolism and floating intracardiac thrombi presenting critical life-threatening conditions.
Objective. To demonstrate the effectiveness of comprehensive conservative treatment in a patient with venous thrombosis complicated by massive pulmonary embolism and floating intracardiac thrombus formation.
Case summary. A 52-year-old male patient presented with acute respiratory failure and desaturation following 7 days of progressive dyspnea. Combined echocardiography and duplex ultrasound scanning identified right popliteal vein thrombosis as the embolic source and revealed a highly mobile 10-12 cm intracardiac thrombus in the right atrium. CT pulmonary angiography confirmed bilateral pulmonary artery thromboembolism involving segmental branches.
Discussion. Implementation of an intensive anticoagulation strategy (unfractionated heparin 25,000 IU/day) followed by systemic thrombolysis (alteplase 50 mg) resulted in the complete resolution of thrombotic masses within 48 hours. A multidisciplinary approach involving a vascular surgeon, a cardiac surgeon, and an intensive care specialist avoided surgical intervention in this patient with high anesthetic risk.
Conclusions. This case illustrates the potential for successful conservative management of critical thromboembolic conditions when early identification of the embolic source, a personalized therapeutic approach, and coordinated multidisciplinary patient management are implemented. The combination of intensive anticoagulation and thrombolytic therapy can effectively resolve massive intracardiac thrombi without surgical intervention.
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