OR11-3 | Comparing Management Strategies in Patients With Clot-in-Transit

Clot-in-transit (CIT) 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 CIT. This is a retrospective study of patients with documented CIT in the right heart on echocardiography across two institutions between January 2020 and October 2023. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest and hemodynamic decompensation. Among 35 patients included in the study, 10 patients (28.6%) received anticoagulation (AC) alone, 2 patients (5.7%) received systemic thrombolysis (ST), 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. When compared with AC alone, patients who received CBT or ST had significantly lower rates of the primary composite outcome (12% vs. 60%, log-rank p<0.001, HR: 0.13; 95% CI: 0.03-0.54, p=0.005) including a lower rate of death (8% vs 50%, log-rank p<0.001, HR: 0.10; 95% CI: 0.02-0.55, p=0.008), resuscitated cardiac arrest (4% vs 30%, log-rank p=0.02, HR: 0.12; 95% CI: 0.01-1.15, p=0.067) and hemodynamic deterioration (4% vs 30%, log-rank p=0.02, HR: 0.12; 95% CI: 0.01-1.15, p=0.067). In this largest study of CBT in patients with CIT to date, CBT or ST was associated with a significantly lower rate of adverse clinical outcomes, including a lower rate of death compared to AC alone. Further large-scale studies are needed to test these associations.