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Meta-Analysis
. 2022 Jan-Dec:28:10760296221140114.
doi: 10.1177/10760296221140114.

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

Wanis H Ibrahim  1 , Fateen Ata  2 , Hassan Choudry  3 , Huzaifa Javed  4 , Khaled M Shunnar  5 , Abdullah Shams  2 , Abdullah Arshad  2 , Adel Bosom  2 , Mohammed H A Elkahlout  2 , Bisher Sawaf  2 , Shahda M A Ahmed  2 , Tinuola Olajide  2
Affiliations
Meta-Analysis

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

Wanis H Ibrahim et al. Clin Appl Thromb Hemost. 2022 Jan-Dec.

Abstract

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.

Keywords: free-Floating right heart thrombi; pulmonary embolism; right heart thrombi.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Echocardiography showing free-floating right atrium thrombus (arrow).
Figure 2.
Figure 2.
PRISMA flow diagram of the article screening process with the details of included and excluded studies.
Figure 3.
Figure 3.
Clinical presentation of FFRHT in the context of PE.
See this image and copyright information in PMC

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