Extract
Right heart thrombi (RHT) may be detected in <4% of patients with pulmonary embolism (PE) [1], and are associated with worse outcomes [1–4]. Given the limited existing evidence, society guidelines or consensus statements have either not addressed the management of RHT, or have based their recommendations on prior case reports, case series or pooled results of case series [5–8]. It is plausible that reperfusion strategies reduce the adverse outcomes in PE patients with RHT; thrombolysis may dissolve the RHT and emboli, while thrombectomy might reduce the thromboembolic burden. Using the data from RIETE (Registro Informatizado Enfermedad TromboEmbolica), a prospective international venous thromboembolism registry, we sought to compare the outcomes of patients with PE and coexisting RHT, with versus without reperfusion therapy.
Abstract
Right heart thrombi portend worse outcomes in pulmonary embolism (PE). In propensity-matched analyses of patients from a large registry, reperfusion therapy was not associated with significantly reduced odds of all-cause or PE-related mortality. https://bit.ly/2WRLYnq
Acknowledgements
We express our gratitude to Sanofi Spain for supporting this registry with an unrestricted educational grant. We also thank the RIETE Registry coordinating centre, S&H Medical Science Service, for their quality control data, logistic and administrative support.
Footnotes
Coordinator of the RIETE Registry: Manuel Monreal. RIETE Steering Committee Members: Paolo Prandoni, Benjamin Brenner and Dominique Farge-Bancel. RIETE National Coordinators: Raquel Barba (Spain), Pierpaolo Di Micco (Italy), Laurent Bertoletti (France), Sebastian Schellong (Germany), Inna Tzoran (Israel), Abilio Reis (Portugal), Marijan Bosevski (R. Macedonia), Henri Bounameaux (Switzerland), Radovan Malý (Czech Republic), Peter Verhamme (Belgium), Joseph A. Caprini (USA), Hanh My Bui (Vietnam). RIETE Registry Coordinating Center: S&H Medical Science Service. Members of the RIETE Group: Spain: Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Arramberri M, Azcarate-Agüero P, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón-Andrés B, Blanco-Molina A, Camon AM, Castro J, Criado J, Culla A, de Miguel J, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche MC, Díaz-Peromingo JA, Díez-Sierra J, Domínguez IM, Escribano JC, Fernández-Capitán C, Fernández-Reyes JL, Fidalgo MA, Flores K, Font C, Font L, Francisco I, Furest I, Gabara C, García MA, García-Bragado F, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Gayol MC, Gil-Díaz A, Gómez-Cuervo C, González-Martínez J, Grau E, Gutiérrez J, Hernando E, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lalueza A, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Meseguer M, López-Miguel P, López-Núñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Marchena PJ, Martín-Asenjo M, Martín-Fernández M, Martín-Guerra JM, Martín-Martos F, Mella C, Mellado M, Mercado MI, Moisés J, Monreal M, Morales MV, Muñoz-Blanco A, Muñoz-Guglielmetti D, Nieto JA, Núñez MJ, Olivares MC, Ortega-Michel C, Ortega-Recio MD, Osorio J, Otero R, Paredes D, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Pérez-Jacoíste A, Pérez-Rus G, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Matute C, Rosa V, Rubio CM, Ruiz-Giménez N, Ruiz-Sada P, Sahuquillo JC, Sala-Sainz MC, Salgueiro G, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Soler S, Suárez S, Suriñach JM, Tapia E, Tiberio G, Torres MI, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Villares P, Zamora C. Argentina: Gutiérrez P, Vázquez FJ. Belgium: Vanassche T, Vandenbriele C, Verhamme P. Czech Republic: Hirmerova J, Malý R. Ecuador: Salgado E. France: Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Courtois MC, Farge-Bancel D, Helfer H, Hij A, Mahé I, Moustafa F. Germany: Schellong S. Israel: Braester A, Brenner B, Tzoran I. Italy: Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Grandone E, Imbalzano E, Maida R, Pace F, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Vo Hong N, Zalunardo B. Latvia: Kigitovica D, Skride A, Strautmane S. Portugal: Ferreira M. Republic Of Macedonia: Bosevski M, Zdraveska M. Switzerland: Bounameaux H, Mazzolai L. USA: Bikdeli B, Caprini JA, Tafur AJ, Weinberg I, Wilkins H. Vietnam: Bui HM.
Conflict of interest: B. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to a specific type of IVC filters.
Conflict of interest: D. Jiménez has nothing to disclose.
Conflict of interest: A. Muriel has nothing to disclose.
Conflict of interest: D. Barrios has nothing to disclose.
Conflict of interest: A. Ballaz has nothing to disclose.
Conflict of interest: P. Verhamme reports honoraria for lectures and consultancy from Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer, BMS and Portola.
Conflict of interest: M. Monreal has nothing to disclose.
Support statement: This work was supported by Bayer Pharma and Sanofi. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received March 4, 2020.
- Accepted May 11, 2020.
- Copyright ©ERS 2020