Comparing mortality of endarterectomy and thrombolytic therapy in pulmonary embolism with right atrial clot during 10 years in Madani Hospital

Abstract

Acute pulmonary embolism is a critical medical condition demanding immediate and rigorous attention. Despite recent advancements in the field, it continues to carry a high mortality rate and presents several challenges in both diagnosis and treatment. Echocardiography has revealed that approximately 4% of patients with pulmonary embolism also exhibit right atrial thrombosis. Consequently, these individuals are subjected to two primary treatment methods—thrombolytic therapy and thromboembolectomy surgery. This study aims to compare mortality outcomes between these two treatment approaches within the Iranian population. Method: This retrospective cross-sectional study encompasses all patients admitted to Tabriz University of Medical Sciences' Shahid Madani Hospital between 2011 and 2021 with a confirmed diagnosis of acute pulmonary embolism accompanied by right atrial thrombosis. Results: In this study, 23 patients with pulmonary embolism and right atrial clot were investigated. The average age of the patients was 54.52 ± 13.67, 39.1% of them were male and 60.9% were female. Sixteen people used anticoagulants and 18 people needed surgery, while only five people used thrombolytic therapy. The results of echocardiography showed that most of the patients had a mobile mass in the right atrium, and most of the patients had right ventricular enlargement and right ventricular dysfunction. In-hospital death occurred in 43.5% of patients and only one death was reported within one year after discharge. A comparison of in-hospital death between different treatment groups showed that there is no significant difference. Also, the analysis showed that blood pressure lower than 100 mmHg and older age are associated with increased in-hospital mortality. Age independently predicted in-hospital mortality.