Turk Kardiyol Dern Ars. 2013; 41(7): 642-645 | DOI: 10.5543/tkda.2013.88288

A huge intracardiac thrombus developed in the presence of antithrombin III deficiency in a patient with end-stage renal failure

Fatih Köksal Binnetoğlu¹, Kadir Babaoğlu¹, Nazan Sarper², Kenan Bek^3
1Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine, Izmit
²Department of Pediatric Hematology, Kocaeli University Faculty of Medicine, Izmit
³Department of Pediatric Nephrology, Kocaeli University Faculty of Medicine, Izmit

In this study, we report a 15-year-old female with end-stage renal disease undergoing hemodialysis, who admitted with acute respiratory failure and generalized edema. Abdominal tomography detected thrombi in the right renal vein, in the hepatic segment of the inferior vena cava and in iliac veins. Levels of proteins C and S, antinuclear antigen, anti-dsDNA, C3, and C4 were in normal limits. The thrombi persisted despite treatment with nadroparin, heparin with fresh frozen plasma and warfarin. Due to heparin resistance, antithrombin III levels were measured and were found abnormally low. The first echocardiographic examination was in normal limits but the second echocardiography revealed a huge thrombus occluding the tricuspid valve. Urgent thrombectomy was planned but the patient died in the intensive care unit due to severe pulmonary edema.

Keywords: Antithrombin III, cardiovascular diseases/etiology, kidney failure, chronic/physiopathology/complications; renal dialysis; thrombosis.

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