Comparing Management Strategies in Patients With Clot-in-Transit
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Updated: Jun 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Robert S Zhang1, Eugene Yuriditsky1, Peter Zhang2
1Division of Cardiovascular Medicine (R.S.Z., E.Y., L.E., M.S., C.L.A., J.M.H., S.B.), New York University.
Insights
Catheter-based therapy (CBT) significantly reduces adverse outcomes for patients with clot-in-transit compared to anticoagulation alone. This approach, including mechanical thrombectomy, offers a promising strategy for improving survival and clinical stability.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Clot-in-transit poses a significant mortality risk, yet optimal management remains unclear.
- Effective treatment strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To compare the clinical outcomes of various treatment strategies for clot-in-transit.
- To evaluate the efficacy of catheter-based therapy (CBT) versus anticoagulation alone.
Main Methods:
- A retrospective analysis of 35 patients with right heart clot-in-transit diagnosed via echocardiography.
- Comparison of outcomes between anticoagulation, systemic thrombolysis, and catheter-based therapy (mechanical thrombectomy or catheter-directed thrombolysis).
- Primary outcome: composite of in-hospital mortality, cardiac arrest, or hemodynamic decompensation.
Main Results:
- Catheter-based therapy (CBT) or systemic thrombolysis significantly reduced the composite adverse outcome rate (12%) compared to anticoagulation alone (60%).
- CBT was associated with lower mortality (8% vs. 50%), resuscitated cardiac arrest (4% vs. 30%), and hemodynamic deterioration (4% vs. 30%) compared to anticoagulation.
- Mechanical thrombectomy was the predominant form of CBT used.
Conclusions:
- Catheter-based therapy (CBT) and systemic thrombolysis are associated with improved clinical outcomes in clot-in-transit patients.
- CBT, particularly mechanical thrombectomy, demonstrates potential for reducing mortality and adverse events.
- Further large-scale studies are warranted to confirm these findings and optimize treatment protocols.
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.
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