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Case Reports
. 2020 Oct 15;4(5):1-6.
doi: 10.1093/ehjcr/ytaa360. eCollection 2020 Oct.

The concoction of cancer, catheter, and intracardiac clot: a case report describing a potential treatment strategy

Raunak Mohan Nair  1 , Anjli Maroo  2
Affiliations
Case Reports

The concoction of cancer, catheter, and intracardiac clot: a case report describing a potential treatment strategy

Raunak Mohan Nair et al. Eur Heart J Case Rep. .

Abstract

Background: Patients with cancer often pose a unique challenge to anticoagulation, as they have a higher risk of bleeding and clotting than the general population. Patients with cancer and catheter-related intracardiac thrombus are a very specific subset of people who do not have specific recommendations guiding their treatment. This article aims to address the existing knowledge gaps in this scenario and provide a possible treatment approach for these patients.

Case summary: We describe the case of a 46-year-old lady with invasive breast cancer, who was on chemotherapy through a central venous catheter and was found to have a right atrial thrombus on routine echocardiography. Due to the paucity of data in this scenario and because the patient requested an oral anticoagulant which did not need frequent monitoring, we started her on apixaban for a total of 3 months. Echocardiogram was repeated at 4 and 8 weeks. In the 8-week echocardiogram, the right atrial thrombus was no longer visualized.

Discussion: Malignancy and central venous catheters significantly increase the risk of thrombosis. Although low molecular weight heparin is the preferred anticoagulant to manage thrombosis in patients with cancer, direct oral anticoagulants have been proven to be non-inferior. In patients with catheter-related intracardiac thrombus, anticoagulation should be continued for at least 3 months or until the catheter is removed, whichever is longer.

Keywords: Anticoagulation; CRT (catheter-related thrombus); Case report; Central venous catheter; Echocardiogram; Intracardiac thrombus; Malignancy.

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Figures

Figure 1
Figure 1
(A) Right atrial thrombus on initial ECHO. (B) Repeat ECHO at 8 weeks showing resolution of thrombus.
Figure 2
Figure 2
This figure depicts the various scenarios and their respective treatment options as per the current guidelines. DOAC, direct oral anticoagulants; LMWH, low molecular weight heparin.
Figure 3
Figure 3
This flowsheet describes our approach to this unique situation based on current evidence. DVT, deep vein thrombosis; LMWH, low molecular weight heparin; UFH, unfractioned heparin.
None
See this image and copyright information in PMC

References

    1. Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2013;31:2189–2204. - PubMed
    1. McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL, Bhatt DL, McEvoy JW.. Left ventricular thrombus after acute myocardial infarction. JAMA Cardiol 2018;3:642. - PubMed
    1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA. et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: executive summary. Circulation 2013;127:529–555. - PubMed
    1. James S, Agewall S, Antunes MJ. et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Authors/Task Force Members: Borja Ibanez (Chairperson). Eur Heart J 2017;39:119–177. - PubMed
    1. Ay C, Beyer-Westendorf J, Pabinger I.. Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants. Ann Oncol 2019;30:897–907. - PMC - PubMed

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