Abstract 386: Rapid Left Ventricular Thrombus Formation After Thrombolysis For Acute Cardioembolic Stroke
Authors: Gribachov A. , Hanafy K. , Lee J. 
Published: January 2025

Introduction/purpose

Thrombolysis with tissue plasminogen activator (tPA) has been utilized as a treatment for acute ischemic stroke in select patients. However, the effects of tPA on the coagulation cascade and its dissolution capabilities are not entirely understood. Cardiac thrombus is often implicated as a cause of cardioembolic strokes, and limited data has suggested that thrombolysis is capable of dissolution of the thrombus (1).

Materials and methods

We present a 39‐year‐old female with multiple vascular risk factors who suffered a cardioembolic stroke for which she received Tenecteplase (TNK) followed by thrombectomy with complete reperfusion.

Results/discussion

She underwent a transthoracic echocardiogram (TTE) with ultrasound contrast the following day which revealed apical hypokinesis demonstrating heart failure with reduced ejection fraction (HFrEF) but no thrombus to the surprise of the cardiology team. Two days later, she had a repeat TTE that showed a new large 1.7times0.8cm LV thrombus, confirmed by the same cardiology team. This finding was unexpected given a thrombus of such size would not be expected to appear in just two days, and raised the possibility that TNK may have dissolved the thrombus and hence why it wasn't visualized on the initial TTE post‐thrombolysis. Another possibility is that the LV thrombus completely embolized to cause the stroke; however, the formation/reformation of a thrombus of that size so quickly was unexpected (5). Literature has suggested that thrombolysis induces a pro‐thrombotic state up to 72 hours afterward (4), with a predilection for cardiac thrombus formation. This may explain why the patient had such a rapid formation/reformation of such a large LV thrombus.

Conclusion

This case presents a potential dual benefit for patients receiving thrombolysis with TNK for cardioembolic stroke, and suggests a potential benefit in undergoing serial echocardiograms in this patient population group.

References

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