Comparing Management Strategies in Patients With Clot-in-Transit.

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  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101499602 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7632 (Electronic) Linking ISSN: 19417640 NLM ISO Abbreviation: Circ Cardiovasc Interv Subsets: MEDLINE
    • Publication Information:
      Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins
    • Subject Terms:
      Thrombolytic Therapy*/adverse effects ; Thrombolytic Therapy*/mortality ; Anticoagulants*/adverse effects ; Anticoagulants*/therapeutic use ; Anticoagulants*/administration & dosage ; Thrombectomy*/adverse effects ; Thrombectomy*/mortality ; Hospital Mortality* ; Fibrinolytic Agents*/administration & dosage ; Fibrinolytic Agents*/adverse effects; Humans ; Male ; Female ; Retrospective Studies ; Aged ; Treatment Outcome ; Middle Aged ; Time Factors ; Risk Factors ; Aged, 80 and over ; Thrombosis/mortality ; Thrombosis/diagnostic imaging ; Thrombosis/etiology ; Heart Arrest/therapy ; Heart Arrest/mortality ; Heart Arrest/physiopathology ; Heart Arrest/diagnosis ; Risk Assessment ; Hemodynamics
    • Abstract:
      Background: Clot-in-transit is associated with high mortality, but optimal management strategies remain uncertain. The aim of this study was to compare the outcomes of different treatment strategies in patients with clot-in-transit.
      Methods: This is a retrospective study of patients with documented clot-in-transit in the right heart on echocardiography across 2 institutions between January 2020 and October 2023. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation.
      Results: Among 35 patients included in the study, 10 patients (28.6%) received anticoagulation alone and 2 patients (5.7%) received systemic thrombolysis, while 23 patients (65.7%) underwent catheter-based therapy (CBT; 22 mechanical thrombectomy and 1 catheter-directed thrombolysis). Over a median follow-up of 30 days, 9 patients (25.7%) experienced the primary composite outcome. Compared with anticoagulation alone, patients who received CBT or systemic thrombolysis had significantly lower rates of the primary composite outcome (12% versus 60%; log-rank P <0.001; hazard ratio, 0.13 [95% CI, 0.03-0.54]; P =0.005) including a lower rate of death (8% versus 50%; hazard ratio, 0.10 [95% CI, 0.02-0.55]; P =0.008), resuscitated cardiac arrest (4% versus 30%; hazard ratio, 0.12 [95% CI, 0.01-1.15]; P =0.067), or hemodynamic deterioration (4% versus 30%; hazard ratio, 0.12 [95% CI, 0.01-1.15]; P =0.067).
      Conclusions: In this study of CBT in patients with clot-in-transit, CBT or systemic thrombolysis was associated with a significantly lower rate of adverse clinical outcomes, including a lower rate of death compared with anticoagulation alone driven by the CBT group. CBT has the potential to improve outcomes. Further large-scale studies are needed to test these associations.
      Competing Interests: Dr Bangalore is on the Advisory Board of Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Merck, Reata, Inari, and Truvic. The other authors report no conflicts.
    • Contributed Indexing:
      Keywords: catheters; pulmonary embolism; thrombectomy; thrombosis
    • Accession Number:
      0 (Anticoagulants)
      0 (Fibrinolytic Agents)
    • Publication Date:
      Date Created: 20240606 Date Completed: 20240820 Latest Revision: 20240820
    • Publication Date:
      20240821
    • Accession Number:
      10.1161/CIRCINTERVENTIONS.124.014109
    • Accession Number:
      38841833