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 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.
authors.affiliation: Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: Deisy
authors.initials: D
authors.lastname: Barrios
authors.affiliation: CHU Saint-Etienne, Service d'accueil des Urgences, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chavant
authors.affiliation: Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.affiliation: Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Rosa-Salazar
authors.affiliation: Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: CHU Saint-Etienne, Service d'accueil des Urgences, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Viallon
authors.affiliation: Department of Internal Medicine, Hospital La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, Mo.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000150:complications* / Q000401:mortality; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Pulmonary embolism; Right heart thrombi; Thrombolysis; Treatment