How to manage a patient with LA clot and Mitral stenosis ?

Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader')); Answer  Though PTMC in the presence of LA clot is an option in low risk clots , my strategy would be the last one ,whenever feasible. Intensive, monitored Heparin /Oral anticoagulants ( Heparin 5000 units tds or qid  or Low molecular weight heparin Enoxaparin  40-60mg twice a day , Tablet Warfarin /Acitrom with an INR of 3 ) will dissolve  LA clot in  30-50% of times.(Our experience). The percutaneous clot retrieval system is not available as on 2018.Aortic filters are FDA approved during TAVR. (Why not use the same in PTMC ?)  LA Catheter based regional lysis through PFO is can be an option if patient agrees to the risk. How long to wait for clot dissolution with Heparin /OAC? Most small clots or intermediate sized clots ((Up to 2 CM ?)  have been dissolved by 3  months. Even large clots gets dissolved at least in few Instances.Please note, this strategy is applicable only with valves that is fit for PTMC. All others are referred for surgery. How does heparin lyse a clot  ? Its a miracle to see it happen, though heparin / OAC are  never considered as thrombolytic agents .It happens because  both heparin ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs