Lucrecia María Burgos1, Juan Pablo Costabel2, Victoria Galizia Brito3, Alan Sigal3, Daniela Maymo4, Ana Iribarren3, Marcelo Trivi5. 1. Clinical Cardiology, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina. Electronic address: lucreciamburgos@gmail.com. 2. Emergency Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina. Electronic address: jpcostabel@icba.com.ar. 3. Clinical Cardiology, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina. 4. Hematology, CEMIC, Buenos Aires, Argentina. 5. Department of Cardiology, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
Abstract
INTRODUCTION: Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial. OBJECTIVE: To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS. METHODS: We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016. RESULTS: 207 patients were analyzed, median age was 60years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p=0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07-5.4, p=0.03), and shock (OR 2.87 (IC 95% 1.3-5.9, p=0.005) showed a statistically significant effect on mortality. CONCLUSION: FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients.
INTRODUCTION: Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial. OBJECTIVE: To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS. METHODS: We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016. RESULTS: 207 patients were analyzed, median age was 60years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p=0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07-5.4, p=0.03), and shock (OR 2.87 (IC 95% 1.3-5.9, p=0.005) showed a statistically significant effect on mortality. CONCLUSION: FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients.
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: Xenofon M Sakellariou; Andreas Efstathopoulos; Konstantinos V Stamatis; Dimitrios N Nikas; Theofilos M Kolettis Journal: Eur J Case Rep Intern Med Date: 2020-09-17