Half-dose thrombolytic therapy in patients with right heart thrombi

The management of floating right heart thrombi (FRHT) in patients with acute pulmonary emboli is controversial. Several recent case series have revealed similar efficacy and better survival rates with systemic thrombolytic therapy than with surgery. In this case series, we present our experience with the efficacy of “half-dose” or “safe-dose” thrombolytic therapy in the resolution of FRHT. Five patients who were admitted with confirmed acute pulmonary emboli and FRHT were included in the present report. Half-dose thrombolytic therapy (50 mg of alteplase) was administered to the patients. Follow-up echocardiography revealed complete resolution of the FRHT and considerable improvement in the right heart function. No bleeding events were recorded. Our small case series shows the efficacy and safety of half-dose thrombolytic therapy in FRHT resolution in a group of patients with high bleeding risk. Our findings should be tested in larger populations.