Management of catheter-related right atrial thrombus in hemodialysis: a systematic review

Hemodialysis catheter-related right atrial thrombus (CRAT) is a rare and fatal complication related with catheter. Treatment recommendations are controversial. We reported our institution’s recent three cases in managing CRAT and review and analyze the reported cases of CRAT in hemodialysis patients.

A systematic search of the PubMed, Embase and Web of Science databases was conducted to identify the therapy and outcome data in hemodialysis CRAT patients.

From 1975 to November 2023, a total of previous 144 cases which reported in the literatures and three new cases in our institution of CRAT in hemodialysis were included and analyzed. Overall mortality was 18.1% (26/144). Most of cases can be detected by echocardiography. Thirty-three patients had no treatment, except for catheter removal, replacement or antibiotics, but eleven of them have died. Thrombolytic therapy was adopted in 14 cases but only nine cases was successful, the remaining cases need to further therapy. Eventually, 71 cases have been treated by anticoagulation and 34 cases received thrombectomy.

We recommend that the replacement of the catheter and anticoagulation combined with thrombolysis is a preferred therapy. Thrombectomy should be considered when other methods fail or new complication happened. Thrombolysis alone has a low success rate but may be useful in combination with anticoagulant therapy.