Treatment of a mobile intracardiac thrombus using ultra-slow low-dose tissue plasminogen activator in combination with heparin.

WHAT IS KNOWN AND OBJECTIVE: Free-floating thrombi in the right heart occur in a subset of patients with pulmonary embolism with high rates of mortality if untreated. Treatment of choice is controversial and likely patient specific as studies have failed to consistently show a significant difference in mortality between options. CASE SUMMARY: We present a case of a 45-year-old female with a mobile right heart thrombus treated with ultra-slow, low-dose t-PA infusion in combination with heparin. WHAT IS NEW AND CONCLUSION: Ultra-slow, low-dose infusion of t-PA may be an option for treatment of mobile intracardiac thrombi.