• Lucrecia María Burgos, Juan Pablo Costabel, Victoria Galizia Brito, Alan Sigal, Daniela Maymo, Ana Iribarren, and Marcelo Trivi.
• Clinical Cardiology, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina. Electronic address: lucreciamburgos@gmail.com.
• Am J Emerg Med. 2018 Jun 1; 36 (6): 911-915.

IntroductionFloating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial.ObjectiveTo compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS.MethodsWe conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016.Results207 patients were analyzed, median age was 60years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p=0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07-5.4, p=0.03), and shock (OR 2.87 (IC 95% 1.3-5.9, p=0.005) showed a statistically significant effect on mortality.ConclusionFRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients.Copyright © 2017 Elsevier Inc. All rights reserved.

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