Right Atrial Thrombosis Provoked by Central Venous Catheter: A Case Report

Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.

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MASSIVE RIGHT ATRIAL THROMBUS ASSOCIATED WITH CENTRAL VENOUS CATHETER: A CASE REPORT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)33219-8 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2592

Author(s):

Marie Caruso ◽

Alex Lazo Vasquez

Keyword(s):

Case Report ◽

Central Venous Catheter ◽

Venous Catheter ◽

Right Atrial ◽

Central Venous ◽

Atrial Thrombus ◽

Right Atrial Thrombus

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Catheter-related right atrial thrombosis

The Journal of Vascular Access ◽

10.1177/1129729819873851 ◽

2019 ◽

Vol 21 (3) ◽

pp. 300-307 ◽

Cited By ~ 6

Author(s):

Minh-Ha Tran ◽

Tanya Wilcox ◽

Phu N Tran

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Primary Treatment ◽

Hemodialysis Patients ◽

Right Atrial ◽

Central Venous ◽

Central Venous Catheter Placement ◽

Catheter Dysfunction ◽

Surgical Thrombectomy ◽

Atrial Thrombosis

Introduction: Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT). Methods: To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups. Results: A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients – 12 (4.0–24.0) weeks compared to 5.5 (1.8–16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position – 27/34 (79.4%) – overshadowed thrombophilia – 16/63 (25.4%) – as a risk factor for CRAT. Conclusion: Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.

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