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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© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
