Key result
In pediatric patients with intracardiac thrombi receiving anticoagulation, the presence of a central venous line was associated with a delayed time to thrombus resolution (HR 0.45).
Why the study?
Optimal anticoagulant duration for pediatric intracardiac thrombi remains ill-defined, and high-risk features warranting long-term anticoagulation have not been established.
Cohort (n=51)
No
In pediatric patients with intracardiac thrombi, 3 to 6 months of anticoagulation is generally effective for resolution, though the presence of a central venous line is associated with delayed response and may warrant longer therapy.
Supports anticoagulation for most pediatric intracardiac thrombi; leaves open optimal duration with central venous lines.
Background: Intracardiac thrombi (ICT) are associated with significant morbidity and mortality. Anticoagulation is the first line of treatment and may be complemented by thrombectomy or thrombolysis. However, optimal anticoagulant duration remains ill-defined. High-risk features of ICT that may warrant long-term anticoagulation therapy have not been established. Objectives: To describe anticoagulation duration and patterns of ICT resolution. To identify potential risk factors for persistent ICT despite anticoagulation. Methods: A single-institution retrospective chart review identified patients diagnosed with ICT by echocardiogram between January 2014 and March 2022. Descriptive statistics and logistic regression were used. The median longest ICT dimension was 1.5 cm (range, 0.4-4.0). The median duration of anticoagulation was 4.3 months (IQR, 2.2-9.1). Among 48 patients who received anticoagulation as first-line treatment, 32 had partial or complete response with 3 to 6 months of anticoagulation, while remaining 16 patients had no response to anticoagulation. Patients with a central venous line had a delayed resolution of ICT [hazards ratio = 0.45 (95% CI, 0.22-0.93)]. Conclusion: Our study demonstrates the wide variability in duration of anticoagulation for children with ICT. Majority of the individuals benefit from 3-to-6 month treatment; however, individuals with a central venous line may benefit from a longer course of anticoagulation. Further large-scale studies are recommended to validate our findings.
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Agarwal et al. (2023) conducted a cohort in Intracardiac thrombi (n=51). Central venous line vs. No central venous line was evaluated on Time to intracardiac thrombus resolution (HR 0.45, 95% CI 0.22-0.93, p=0.032). In pediatric patients with intracardiac thrombi receiving anticoagulation, the presence of a central venous line was associated with a delayed time to thrombus resolution (HR 0.45).
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