An Evasive Case of Right Atrial Thrombus: A Need For Evidence-Based Guidelines

treatment of pulmonary emboli with hypotension (e.g., systolic BP<90 mm Hg) in patients who do not have a high bleeding risk, were in favor of systemic thrombolytic therapy over catheterdirected thrombolysis (Grade 2C) [8]. If appropriate expertise and resources are available, catheter-directed thrombus removal was suggested as the mode of intervention in patients with acute PE associated with hypotension and who have either high bleeding risk, failed systemic thrombolysis, or shock that is likely to cause death before systemic thrombolysis can take effect (e.g., within hours) (Grade 2C) [8]. In patients with mobile right heart thrombi, the therapeutic benefits of thrombolysis remain controversial. Good results were reported in some series, [9, 10] but in other reports short-term mortality exceeded 20% despite thrombolysis [2, 6, 11].