Clinical features, management, and outcomes of right heart thrombi: a retrospective cohort study

Right heart thrombi (RHT) are a rare entity with high morbidity and mortality. There are no societal guidelines on the management of intracardiac thrombi. In an effort to understand the clinical elements associated with treatment decisions for RHT, this retrospective multi-center cohort study evaluated a real-world diverse patient population treated at two academic medical centers with PE response team (PERT) programs who presented with RHT, with and without PE, and evaluated the associated treatment strategies and outcomes. This study examined the clinical features and outcomes among patients presenting with RHT who were treated with anticoagulation monotherapy, systemic thrombolysis, and advanced intervention. Outcomes of interest included 30-day mortality, duration of hospitalization, need for ICU admission, bleeding complications, and in-hospital mortality. A total of 48 adult patients with RHT identified by transthoracic echocardiography (TTE) between January 2010 and December 2022 were included. Most patients with RHT presented with intermediate-high or high risk PE with right heart dysfunction. Mortality at 30 days was higher in the anticoagulation monotherapy group when compared to the systemic thrombolysis and advanced intervention groups, though not reaching statistical significance (25 % vs 11 % and 5.6 %, respectively). Other outcomes were not significantly different between groups. Although it is not clear that advanced therapy offers a benefit in this population overall, there are likely patients who will benefit; identifying that subpopulation remains a key question.