Case studies in cardiovascular nursing| Volume 36, ISSUE 2, P148-153, March 2007

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Herpes simplex virus infection, massive pulmonary thromboembolism, and right atrial thrombi in a single patient: Case report

      We report a 32-year-old man with herpes simplex virus encephalitis who developed massive pulmonary thromboembolism with mobile right atrial thrombi during treatment for this condition. It was not safe to use thrombolytic therapy because of the high risk of cerebral bleeding associated with encephalitis. The patient was initially treated at another center, but his condition deteriorated during nadroparin therapy and he was referred to our hospital. Nadroparin was discontinued, and a continuous infusion of unfractionated heparin was administered through a central venous catheter. The patient’s general status improved over the next 24 hours, and all thrombi in the right atrium disappeared. There was immediate lysis of the thrombi after the continuous infusion of unfractionated heparin was initiated. We suggest that central-line infusion of this agent is preferable to peripheral infusion in such cases. Further research on the potential thrombolytic effect of heparin is needed.
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        • Chapoutot L.
        • Nazeyrollas P.
        • Metz D.
        • Maes D.
        • Maillier B.
        • Jennesseaux C.
        • et al.
        Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management.
        Cardiology. 1996; 87: 169-174
        • Casazza F.
        • Bongarzoni A.
        • Centonze F.
        • Morpurgo M.
        Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism.
        Am J Cardiol. 1997; 79: 1433-1435
        • Hirsh J.
        • Lee A.Y.
        How we diagnose and treat deep vein thrombosis.
        Blood. 2002; 99: 3102-3110
        • Hirsh J.
        • Hoak J.
        • Council on Thrombosis, American Heart Association
        Management of deep vein thrombosis and pulmonary embolism: a statement for healthcare professionals.
        Circulation. 1996; 93: 2212-2245
        • Perry S.L.
        • Ortel T.L.
        Clinical and laboratory evaluation of thrombophilia.
        Clin Chest Med. 2003; 24: 153-170
        • Sutherland M.R.
        • Raynor C.M.
        • Leenknegt H.
        • Wright J.F.
        • Pryzdial E.L.
        Coagulation initiated on herpesviruses.
        Proc Natl Acad Sci U S A. 1997; 94: 13510-13514
        • Vercellotti G.M.
        Proinflammatory and procoagulant effects of herpes simplex infection on human endothelium.
        Blood Cells. 1990; 16: 209-215
        • Nicholson A.C.
        • Hajjar D.P.
        Herpesviruses in atherosclerosis and thrombosis: etiologic agents or ubiquitous bystanders.
        Arterioscler Thromb Vasc Biol. 1998; 18: 339-348
        • Morris T.A.
        Management of pulmonary thromboembolic disease.
        in: Baum’s textbook of pulmonary diseases. Lippincott Williams & Wilkins, Philadelphia2004: 747-771
        • Rose P.S.
        • Punjabi N.M.
        • Pearse D.B.
        Treatment of right heart thromboemboli.
        Chest. 2002; 121: 806-814
        • Chartier L.
        • Bera J.
        • Delomez M.
        • Asseman P.
        • Beregi J.P.
        • Bauchart J.J.
        • et al.
        Free-floating thrombi in the right heart: diagnosis, management and prognostic indexes in 38 consecutive patients.
        Circulation. 1999; 99: 2779-2783
        • Mangin L.
        • Tremel F.
        • Cracowski J.L.
        • Chavanon O.
        • Mallion J.M.
        • Baguet J.P.
        Pulmonary embolism with right intra-auricular thrombus.
        Presse Med. 2002; 31: 1454-1457