A Contemporary Approach to Diagnosis and Treatment of Right Heart Thrombus Associated With Pulmonary Embolism

Right heart thrombus (RHT) in the setting of pulmonary embolism (PE) is a uniquely high-risk event. RHT management has not been rigorously studied in clinical trials and is not part of risk stratification schemas for PE. However, it is a major risk factor for clinical deterioration and mortality. There are no guidelines for RHT management, and most practice is based on case series and anecdote. Historically, RHT has been managed with surgical embolectomy or systemic thrombolysis; however, there is now increasing experience with catheter-based mechanical thrombectomy. Furthermore, a subset of patients with RHT can be treated with anticoagulation monotherapy. In this article, the authors use existing evidence for diagnostic tools and outcomes data to provide a practical framework for approaching RHT in the setting of PE.