Treatment of Right Heart Thromboemboli

Catheter-related atrial thrombosis in a patient with recent cerebral haemorrhage: to treat or not to treat?

“…This is likely because by far the vast majority of right heart thromboemboli entail embolized material from deep venous thromboses temporarily lodged in the right atrium or ventricle, which are usually referred to as emboli in transit. In fact, nearly all patients with right heart thromboembolism have coexisting massive bilateral pulmonary emboli [4]. Based on a systematic review of the literature Rose et al [4] conclude that the most effective therapy for patients with right heart thromboemboli remains unknown.…”

“…In fact, nearly all patients with right heart thromboembolism have coexisting massive bilateral pulmonary emboli [4]. Based on a systematic review of the literature Rose et al [4] conclude that the most effective therapy for patients with right heart thromboemboli remains unknown. This is very worrying since the presence of a right heart thromboembolus, particularly complicating a pulmonary thromboembolism, carries a poor prognosis.…”

“…At variance, a recent survey of all patients with right heart thromboembolism that have been reported in the English language literature shows that thrombolytic therapy is associated with a reduction in mortality compared to anticoagulation or surgical therapy. [4].…”

Right heart thrombi: Consider the cause

“…The overall mortality for type A thrombi is 28% to 44% (2,3,6,9). Although the prevalence of type B thrombi is unknown, they portend better outcomes than type A thrombi (6,9,10).…”

“…Thrombolytics may prove to be lifesaving for patients with acute pulmonary embolism complicated by a type A thrombus. Without treatment, mortality is reported to be 100% (2). Because distal propagation of type A thrombi occurs early, thrombolytics are invaluable, particularly at centres without immediate access to cardiac surgery.…”