title: Comparative efficacy of different modalities for treatment of right heart thrombi in transit: a pooled analysis.
abstract: The objective was to compare the efficacy of treatment options for right heart thrombi (RHT) in transit. All published reports between 1992 and 2013 were identified and pooled. We analyzed 328 patients with RHT and pulmonary embolism (PE). The treatments administered were none in 11 patients (3.4%), anticoagulation (AC) with heparin in 70 patients (21.3%), thrombolytics in 122 patients (37.2%), catheter-related treatments in five patients (1.5%) and surgical embolectomy in 120 patients (36.6%). The overall short-term mortality for the entire cohort was 23.2%. The mortality rate associated with no therapy was highest at 90.9%. The mortality associated with AC alone was significantly higher than surgical embolectomy or thrombolysis (37.1% vs 18.3% vs 13.7%, respectively). In univariate analysis, any therapy was better than no therapy with a favorable odds of 16.92 (95% CI 2.05-139.87) for AC, 61.76 (95% CI 7.42-513.81) for thrombolysis and 44.54 (95% CI 5.42-366.32) for surgical embolectomy. In multivariate analysis with age and hemodynamic status entered as covariates, thrombolytic therapy was better than AC with favorable odds of 4.83 (95% CI 1.52-15.36). Similarly, there was a trend in favor of surgical embolectomy with an odds of 2.61 (95% CI 0.90-7.58). The estimated probability of survival in hemodynamically unstable patients with AC, surgical embolectomy and thrombolysis was 47.7%, 70.45% and 81.5%, respectively. There was no significantly increased risk of complications with thrombolytic therapy. In conclusion, left untreated, patients with RHT and PE have very high mortality. Aggressive management with thrombolysis or surgical thrombectomy may be more effective than AC alone in the management of these patients.
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sengodan
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Chacko
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA sgandhi@metrohealth.org.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D017128:Embolectomy / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulation; pulmonary embolism; right atrial thrombus; right heart thrombus in transit; surgical embolectomy; thrombolysis