Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

Deisy Barrios, Jeremy Chavant, David Jiménez, Laurent Bertoletti, Vladimir Rosa-Salazar, Alfonso Muriel, Alain Viallon, Carmen Fernández-Capitán, Roger D. Yusen, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan MalýPhilip Wells, Peter Verhamme, M. D. Adarraga, M. A. Aibar, M. Alfonso, J. I. Arcelus, P. M. Azcarate-Agüero, A. Ballaz, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, G. Cañada, I. Cañas, I. Casado, N. Chic, R. del Pozo, J. del Toro, M. C. Díaz-Pedroche, J. A. Díaz-Peromingo, C. Falgá, C. Fernández-Aracil, M. A. Fidalgo, C. Font, L. Font, P. Gallego, M. A. García, F. García-Bragado, P. García-Brotons, O. Gavín, C. Gómez, V. Gómez, J. González, E. Grau, A. Grimón, L. Guirado, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, L. Jara-Palomares, M. J. Jaras, J. Jiménez, M. D. Joya, P. Llamas, J. L. Lobo, P. López, L. López-Jiménez, R. López-Reyes, J. B. López-Sáez, M. A. Lorente, A. Lorenzo, J. M. Luque, P. J. Marchena, C. Martínez, F. Martín-Martos, J. A. Nieto, S. Nieto, A. Núñez, M. J. Núñez, S. Otalora, R. Otero, J. M. Pedrajas, G. Pérez, C. Pérez-Ductor, M. L. Peris, I. Pons, J. A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, M. Rodríguez, M. A. Rodríguez-Dávila, J. C. Sahuquillo, M. C. Sala-Sainz, A. Sampériz, R. Sánchez-Martínez, O. Sanz, S. Soler, B. Sopeña, J. M. Suriñach, C. Tolosa, M. I. Torres, J. Trujillo-Santos, F. Uresandi, E. Usandizaga, B. Valero, R. Valle, J. Vela, G. Vidal, C. Vilar, B. Xifre, T. Vanassche, H. H.B. Yoo, J. Hirmerova, E. Salgado, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, F. Moustafa, A. Braester, G. Antonucci, G. Barillari, F. Bilora, A. Bonanome, C. Bortoluzzi, B. Brandolin, M. Ciammaichella, P. De Ciantis, F. Dentali, R. Duce, M. Giorgi-Pierfranceschi, E. Grandone, E. Imbalzano, G. Lessiani, R. Maida, D. Mastroiacovo, F. Pace, R. Parisi, R. Pesavento, M. Pinelli, R. Poggio, R. Quintavalla, A. Rocci, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, V. Gibietis, A. Skride, B. Vitola, M. Zdraveska, L. Mazzolai

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28 Scopus citations

Abstract

Background Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Methods This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbólica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism–related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. Results Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score–matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism–related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). Conclusions In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulation. Right heart thrombi may not warrant riskier interventions than standard anticoagulation.

Original languageEnglish
Pages (from-to)588-595
Number of pages8
JournalAmerican Journal of Medicine
Volume130
Issue number5
DOIs
StatePublished - May 2017

Keywords

  • Anticoagulation
  • Pulmonary embolism
  • Right heart thrombi
  • Thrombolysis
  • Treatment

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