Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism.
Details
Serval ID
serval:BIB_D1318D821C87
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism.
Journal
The American journal of medicine
Working group(s)
Registro Informatizado de la Enfermedad TromboEmbólica Investigators
Contributor(s)
Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Bertoletti L., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Verhamme P., Adarraga M.D., Aibar M.A., Alfonso M., Arcelus J.I., Azcarate-Agüero P.M., Ballaz A., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañada G., Cañas I., Casado I., Chic N., Del Pozo R., Del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Aracil C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Gallego P., García M.A., García-Bragado F., García-Brotons P., Gavín O., Gómez C., Gómez V., González J., Grau E., Grimón A., Guirado L., Gutiérrez J., Hernández-Comes G., Hernández-Blasco L., Jara-Palomares L., Jaras M.J., Jiménez D., Jiménez J., Joya M.D., Llamas P., Lobo J.L., López P., López-Jiménez L., López-Reyes R., López-Sáez J.B., Lorente M.A., Lorenzo A., Luque J.M., Marchena P.J., Martínez C., Martín-Martos F., Monreal M., Nieto J.A., Nieto S., Núñez A., Núñez M.J., Otalora S., Otero R., Pedrajas J.M., Pérez G., Pérez-Ductor C., Peris M.L., Pons I., Porras J.A., Reig O., Riera-Mestre A., Riesco D., Rivas A., Rodríguez M., Rodríguez-Dávila M.A., Rosa V., Sahuquillo J.C., Sala-Sainz M.C., Sampériz A., Sánchez-Martínez R., Sanz O., Soler S., Sopeña B., Suriñach J.M., Tolosa C., Torres M.I., Trujillo-Santos J., Uresandi F., Usandizaga E., Valero B., Valle R., Vela J., Vidal G., Vilar C., Xifre B., Vanassche T., Verhamme P., Yoo HHB, Wells P., Hirmerova J., Malý R., Salgado E., Bertoletti L., Bura-Riviere A., Farge-Bancel D., Hij A., Mahé I., Merah A., Moustafa F., Braester A., Brenner B., Tzoran I., Antonucci G., Barillari G., Bilora F., Bonanome A., Bortoluzzi C., Brandolin B., Ciammaichella M., De Ciantis P., Dentali F., Di Micco P., Duce R., Giorgi-Pierfranceschi M., Grandone E., Imbalzano E., Lessiani G., Maida R., Mastroiacovo D., Pace F., Parisi R., Pesavento R., Pinelli M., Poggio R., Prandoni P., Quintavalla R., Rocci A., Tiraferri E., Tonello D., Tufano A., Venturelli U., Visonà A., Gibietis V., Skride A., Vitola B., Bosevski M., Zdraveska M., Bounameaux H., Mazzolai L.
ISSN
1555-7162 (Electronic)
ISSN-L
0002-9343
Publication state
Published
Issued date
05/2017
Peer-reviewed
Oui
Volume
130
Number
5
Pages
588-595
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism.
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.
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).
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.
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.
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).
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/adverse effects, Anticoagulants/therapeutic use, Cause of Death, Female, Heart Diseases/complications, Heart Diseases/drug therapy, Heart Diseases/surgery, Hemorrhage/chemically induced, Humans, Male, Middle Aged, Propensity Score, Pulmonary Embolism/complications, Pulmonary Embolism/mortality, Recurrence, Thrombolytic Therapy/adverse effects, Thrombosis/complications, Thrombosis/drug therapy, Thrombosis/surgery, Treatment Outcome, Anticoagulation, Pulmonary embolism, Right heart thrombi, Thrombolysis, Treatment
Pubmed
Web of science
Create date
12/10/2018 12:45
Last modification date
20/08/2019 15:51
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