Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3323-3329
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3323
Successful treatment of veno-arterial extracorporeal membrane oxygenation complicated with left ventricular thrombus by intravenous thrombolysis: A case report
Ya-Dong Wang, Jin-Feng Lin, Xiao-Ying Huang, Xu-Dong Han
Ya-Dong Wang, Intensive Care Medicine, Nantong Third People's Hospital, Nantong 226000, Jiangsu Province, China
Jin-Feng Lin, Xiao-Ying Huang, Xu-Dong Han, Critical Care Medicine, Nantong Third People’s Hospital, Nantong 226000, Jiangsu Province, China
Author contributions: Wang YD wrote the article, Lin JF reviewed the medical records, Huang XY conducted the literature review and Han XD revised the article; all authors have read and approved the final version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient to publish this case report and accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xu-Dong Han, MD, Chief Physician, Critical Care Medicine, Nantong Third People’s Hospital, No. 60 Qingnian Road, Nantong 226000, Jiangsu Province, China.
Received: February 13, 2023
Peer-review started: February 13, 2023
First decision: March 14, 2023
Revised: March 22, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 16, 2023

Left ventricular thrombus is a rare condition, for which appropriate treatments are not extensively studied. Although it can be treated by thrombectomy, such surgery can be difficult and risky, and not every patient can tolerate the surgery.


We report a case of a middle-aged man receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for acute myocardial infarction who developed left ventricular thrombus despite systemic anticoagulation. After systemic thrombolysis with urokinase, the left ventricular thrombus disappeared, ECMO was successfully withdrawn 9 days later, and the patient recovered and was discharged from hospital.


Systemic thrombolysis is a treatment option for left ventricular thrombus in addition to anticoagulation and thrombectomy.

Keywords: Extracorporeal membrane oxygenation, Left ventricular thrombus, Thrombolysis, Case report

Core Tip: Urokinase is a useful medicine for thrombolysis. This is the first case report of urokinase administration for left ventricular thrombus occurring during veno-arterial extracorporeal membrane oxygenation therapy. Systemic thrombolytic therapy with urokinase can be considered when the effect of anticoagulant therapy is poor or the risk of surgical treatment is high after left ventricular thrombus formation.