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Anticoagulants vs thrombolytic therapy for the management of right heart thrombus in pulmonary embolism: A systematic review
Kristina G Pereverzeva, Sergey S Yakushin, Natalia N Peregudova, Department of Hospital Therapy with a Course in Medical and Social Expertise, Federal State Budgetary Educational Institution of Higher Education I.P. Pavlov Ryazan State Medical University of the Ministry of Health of the Russian Federation, Ryazan 390026, Russia
Author contributions: Pereverzeva KG performed the study conceptualization, methodology, data curation, drafting of the manuscript and editing of the subsequent versions, and supervision of the project; Peregudova NN performed the literature review data curation, drafting of the manuscript and editing of the subsequent versions; Yakushin SS performed the study conceptualization, provided critical resources, contributed to the reviewing and editing of the various manuscript versions, and performed project administration.
Conflict-of-interest statement: There are no conflicts of interest associated with the senior author or other coauthors who contributed their efforts in this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Sergey S Yakushin, Department of Hospital Therapy with a Course in Medical and Social Expertise, Federal State Budgetary Educational Institution of Higher Education I.P. Pavlov Ryazan State Medical University of the Ministry of Health of the Russian Federation, 96 Stroykova Street, Ryazan 390026, Russia. s.yakushin@rzgmu.ru
Received: February 28, 2026
Revised: April 21, 2026
Accepted: May 6, 2026
Published online: June 26, 2026
Processing time: 120 Days and 20.2 Hours
Revised: April 21, 2026
Accepted: May 6, 2026
Published online: June 26, 2026
Processing time: 120 Days and 20.2 Hours
Core Tip
Core Tip: Management of patients with right heart thrombi in pulmonary embolism (PE) remains challenging. This meta-analysis of 205 patients did not reveal a significant advantage of routine thrombolytic therapy over isolated anticoagulation in reducing mortality. Our data do not support universal use of either strategy. Treatment decisions should be individualized, and clinicians should follow current guidelines, which recommend thrombolysis for hemodynamically unstable patients with massive PE.