Deisy Barrios1, Jeremy Chavant2, David Jiménez3, Laurent Bertoletti4, Vladimir Rosa-Salazar5, Alfonso Muriel6, Alain Viallon2, Carmen Fernández-Capitán7, Roger D Yusen8, Manuel Monreal9. 1. Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. 2. CHU Saint-Etienne, Service d'accueil des Urgences, France. 3. Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address: djimenez.hrc@gmail.com. 4. CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, France. 5. Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain. 6. Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 7. Department of Internal Medicine, Hospital La Paz, Madrid, Spain. 8. Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, Mo. 9. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Spain.
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.
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: Claudia Coscia; Ana Jaureguizar; Carlos Andres Quezada; Alfonso Muriel; Manuel Monreal; Tomas Villén; Esther Barbero; Diana Chiluiza; Roger D Yusen; David Jimenez Journal: Chest Date: 2018-10-25 Impact factor: 9.410
Authors: Belinda Rivera-Lebron; Michael McDaniel; Kamran Ahrar; Abdulah Alrifai; David M Dudzinski; Christina Fanola; Danielle Blais; David Janicke; Roman Melamed; Kerry Mohrien; Elizabeth Rozycki; Charles B Ross; Andrew J Klein; Parth Rali; Nicholas R Teman; Leoara Yarboro; Eugene Ichinose; Aditya M Sharma; Jason A Bartos; Mahir Elder; Brent Keeling; Harold Palevsky; Soophia Naydenov; Parijat Sen; Nancy Amoroso; Josanna M Rodriguez-Lopez; George A Davis; Rachel Rosovsky; Kenneth Rosenfield; Christopher Kabrhel; James Horowitz; Jay S Giri; Victor Tapson; Richard Channick Journal: Clin Appl Thromb Hemost Date: 2019 Jan-Dec Impact factor: 2.389
Authors: Behnood Bikdeli; José Luis Lobo; David Jiménez; Philip Green; Carmen Fernández-Capitán; Alessandra Bura-Riviere; Remedios Otero; Marco R DiTullio; Silvia Galindo; Martin Ellis; Sahil A Parikh; Manuel Monreal Journal: J Am Heart Assoc Date: 2018-09-04 Impact factor: 5.501