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

Research output: Contribution to journalArticle

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

Fingerprint

Pulmonary Embolism
Thrombosis
Reperfusion
Propensity Score
Therapeutics
Mortality
Hemorrhage
Confidence Intervals
Matched-Pair Analysis
Recurrence
Venous Thromboembolism
Anticoagulants
Registries
Cause of Death
Incidence

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., ... 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

Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism. / Barrios, Deisy; Chavant, Jeremy; Jiménez, David; Bertoletti, Laurent; Rosa-Salazar, Vladimir; Muriel, Alfonso; Viallon, Alain; Fernández-Capitán, Carmen; Yusen, Roger D; Monreal, Manuel; Registro Informatizado de la Enfermedad TromboEmbólica Investigators ; Grandone, Elvira.

In: American Journal of Medicine, Vol. 130, No. 5, 05.2017, p. 588-595.

Research output: Contribution to journalArticle

Barrios, D, Chavant, J, Jiménez, D, Bertoletti, L, Rosa-Salazar, V, Muriel, A, Viallon, A, Fernández-Capitán, C, Yusen, RD, 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, vol. 130, no. 5, pp. 588-595. https://doi.org/10.1016/j.amjmed.2016.11.027
Barrios D, Chavant J, Jiménez D, Bertoletti L, Rosa-Salazar V, Muriel A et al. Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism. American Journal of Medicine. 2017 May;130(5):588-595. https://doi.org/10.1016/j.amjmed.2016.11.027
Barrios, Deisy ; Chavant, Jeremy ; Jiménez, David ; Bertoletti, Laurent ; Rosa-Salazar, Vladimir ; Muriel, Alfonso ; Viallon, Alain ; Fernández-Capitán, Carmen ; Yusen, Roger D ; Monreal, Manuel ; Registro Informatizado de la Enfermedad TromboEmbólica Investigators ; Grandone, Elvira. / Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism. In: American Journal of Medicine. 2017 ; Vol. 130, No. 5. pp. 588-595.
@article{4a67cedcab3c4789b715badf0e24354c,
title = "Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism",
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 TromboEmb{\'o}lica 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.",
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",
author = "Deisy Barrios and Jeremy Chavant and David Jim{\'e}nez and Laurent Bertoletti and Vladimir Rosa-Salazar and Alfonso Muriel and Alain Viallon and Carmen Fern{\'a}ndez-Capit{\'a}n and Yusen, {Roger D} and Manuel Monreal and {Registro Informatizado de la Enfermedad TromboEmb{\'o}lica Investigators} and Elvira Grandone",
note = "Copyright {\circledC} 2016 Elsevier Inc. All rights reserved.",
year = "2017",
month = "5",
doi = "10.1016/j.amjmed.2016.11.027",
language = "English",
volume = "130",
pages = "588--595",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism

AU - Barrios, Deisy

AU - Chavant, Jeremy

AU - Jiménez, David

AU - Bertoletti, Laurent

AU - Rosa-Salazar, Vladimir

AU - Muriel, Alfonso

AU - Viallon, Alain

AU - Fernández-Capitán, Carmen

AU - Yusen, Roger D

AU - Monreal, Manuel

AU - Registro Informatizado de la Enfermedad TromboEmbólica Investigators

AU - Grandone, Elvira

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2017/5

Y1 - 2017/5

N2 - 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.

AB - 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.

KW - Aged

KW - Anticoagulants

KW - Cause of Death

KW - Female

KW - Heart Diseases

KW - Hemorrhage

KW - Humans

KW - Male

KW - Middle Aged

KW - Propensity Score

KW - Pulmonary Embolism

KW - Recurrence

KW - Thrombolytic Therapy

KW - Thrombosis

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1016/j.amjmed.2016.11.027

DO - 10.1016/j.amjmed.2016.11.027

M3 - Article

C2 - 28011316

VL - 130

SP - 588

EP - 595

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 5

ER -