Early administration of therapeutic anticoagulation following intravenous thrombolysis for acute cardiogenic embolic stroke caused by left ventricular thrombus: case report and topic review Journal Article

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Authors: Gill, R; Donahey, E; Ruland, S
Article Title: Early administration of therapeutic anticoagulation following intravenous thrombolysis for acute cardiogenic embolic stroke caused by left ventricular thrombus: case report and topic review
Abstract: Cardiogenic cerebral embolism represents 20% of all acute ischemic strokes (AISs) with one-third of these being caused by left ventricular thrombus (LVT). LVT is not a contraindication for treatment with intravenous recombinant tissue plasminogen activator (IV rtPA) for AIS. However, the subsequent treatment of a potentially unstable LVT is contraindicated for 24 h following the use of IV rtPA according to current guidelines. We present a 66-year-old man with AIS treated with IV rtPA. Echocardiogram shortly after treatment demonstrated both a large apical and septal thrombus in the left ventricle and at 12 h post IV rtPA infusion, therapeutic anticoagulation with heparin was started without complication. In practice, the action of IV rtPA outlasts its apparent half-life because of thrombin-binding and the prolonged effects and longer half-life of its product, plasmin; however, the pharmacokinetics do not warrant prolonged avoidance of therapeutic anticoagulation when clinically indicated. Our case demonstrates that anticoagulation for potentially unstable LVT can be safely initiated at 12 h following IV rtPA treatment for AIS.
Journal Title: Frontiers in neurology
Volume: 6
ISSN: 1664-2295; 1664-2295
Publisher: Unknown  
Journal Place: Switzerland
Date Published: 2015
Start Page: 9
Language: eng
DOI/URL:

10.3389/fneur.2015.00009
Notes: LR: 20150225; JID: 101546899; OID: NLM: PMC4313703; OTO: NOTNLM; 2015 [ecollection]; 2014/11/14 [received]; 2015/01/12 [accepted]; 2015/02/02 [epublish]; epublish