Free-floating right heart thrombus with pulmonary embolism in SARS-CoV-2 patient

Juanola, Jordi; Rodriguez, Berta Ferreiro; Tirado, Concepció Falga

doi:10.1016/j.medcli.2020.06.014

Cited by 1 publication

(1 citation statement)

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“…27 Interestingly, COVID-19 infection was reported as the main risk factor in 3% of cases in the current review. 20,[28][29][30][31][32] Recent evidence suggests that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with different cellular molecules including enzymes, endothelial cells, platelets, neutrophil extracellular traps, thrombin, and histones, resulting in endothelial damage and formation of microthrombi. 33 In agreement with the prior evidence, 34 we found that combined CVS diseases (including CAD disease, valvular disease, atrial fibrillation, and patent foramen ovale "PFO") to be the most commonly reported comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis

Ibrahim

Ata

Choudry

et al. 2022

Clin Appl Thromb Hemost

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Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p: 0.027), chest pain ( p: 0.006), and obstructive shock ( p: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p: 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p: 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p: 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p: 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.

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