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, Registro Informatizado de la Enfermedad TromboEmbólica Investigators, Elvira Grandone

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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
Publication statusPublished - May 2017

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Keywords

  • Aged
  • Anticoagulants
  • Cause of Death
  • Female
  • Heart Diseases
  • Hemorrhage
  • Humans
  • Male
  • Middle Aged
  • Propensity Score
  • Pulmonary Embolism
  • Recurrence
  • Thrombolytic Therapy
  • Thrombosis
  • Treatment Outcome
  • Journal Article

Cite this

Barrios, D., Chavant, J., Jiménez, D., Bertoletti, L., Rosa-Salazar, V., Muriel, A., Viallon, A., Fernández-Capitán, C., Yusen, R. D., Monreal, M., Registro Informatizado de la Enfermedad TromboEmbólica Investigators, & Grandone, E. (2017). Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism. American Journal of Medicine, 130(5), 588-595. https://doi.org/10.1016/j.amjmed.2016.11.027