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This letter was referred to Dr. Erkut, who replies in this manner:
I have read the letter, “A Third Treatment Option for Entrapped Thrombus in Patent Foramen Ovale” by Karabay and colleagues. They suggest the use of heparin as a third therapy for entrapped cardiac thrombi. I congratulate them on their successful application of this treatment.
Alternative treatment methods must be considered individually in patients with entrapped thrombi, in accordance with the situation of the patient and the thrombi. When surgical removal seems too hazardous or inconvenient—especially in elderly patients—the use of heparin and oral anticoagulants with echocardiographic follow-up may be the best choice.
Anticoagulation and thrombolytic therapy during medical treatment can lead to secondary complications such as embolization, that can threaten the life of the patient; however, there is no report of such a complication after surgery.
In brief, I agree that heparin therapy should be given to high-risk elderly surgical patients and to those for whom thrombolytic therapy would not be suitable.