Pulmonary embolism with clot in transit: An analysis of risk factors and outcomes

Garvey, Shannon; Dudzinski, David M.; Giordano, N.; Torrey, Jasmine; Kabrhel, Christopher

doi:10.1016/j.thromres.2020.01.006

Cited by 16 publications

(9 citation statements)

References 14 publications

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“…Most importantly, evidence of a thrombus in the right heart, sometimes also referred to as clot-in-transit, was found in 7.6% of our cases and was associated with a mortality of 37.5%. The few prior reports on this, previously thought to be a very rare entity, noted a mortality of 12.5-45% (15,16). The 34 patients who did not have right heart strain all survived their admission.…”

Section: Discussionmentioning

confidence: 88%

Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes

Wong

Kushnir

Billett

2021

Critical Care Explorations

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OBJECTIVES: Saddle pulmonary embolism is an uncommon type of venous thromboembolism that can lead to sudden hemodynamic collapse and death. Saddle pulmonary embolism can be difficult to recognize, and data on its presentation, clinical features, and associated complications are sparse. We sought to characterize patients with saddle pulmonary embolism. DESIGN: The Montage software (Nuance, Burlington, MA) was used to identify patients to create a retrospective cohort study. SETTING: Montefiore Medical Center from January 1, 2012, to December 31, 2018. PATIENTS: All subjects diagnosed with saddle pulmonary embolism in above time period. INTERVENTIONS: Charts were reviewed for demographics, diagnostics, laboratory data, presenting vital signs, inhospital mortality, 6-month survival, and prevalence of recurrent venous thromboembolism. MEASUREMENTS AND MAIN RESULTS: About 120 patients with saddle pulmonary embolism were identified. Median age was 61 years and 57.5% were women. Events were provoked by a transient risk factor in 43.3%. On presentation, median mean arterial pressures were normal (93 mm Hg). Only five of 120 of patients (4.2%) presented with vitals concerning for massive pulmonary embolism. We found a 9.2% inhospital mortality; an additional 8.6% died within 6 months of discharge. Inhospital mortality was higher in women (11.6%), compared with men (3.9%), but this was not significant ( p = 0.28). In 10 patients, both ventilation/perfusion scans and computed tomography pulmonary angiogram were performed. None of the ventilation/perfusion scans diagnosed saddle pulmonary embolism. Thrombus was visualized in the right heart in eight of 105 (7.6%), and this group had a higher inhospital mortality (37.5%). Recurrent venous thromboembolism occurred in 13 of 85 of survivors (15.3%). CONCLUSIONS: Despite presenting without the accepted clinical criteria for massive pulmonary embolism, saddle pulmonary embolism has a very high inhospital mortality. Ventilation/perfusion scan is unable to diagnose saddle pulmonary embolism. Visualized right heart thrombi portend an even higher inhospital mortality.

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Section: Discussionmentioning

confidence: 88%

Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes

Wong

Kushnir

Billett

2021

Critical Care Explorations

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“…Several risk factors for the development of CIT have been identified. In a case series of 665 PE patients comparing those with and without CIT, Garvey et al found that patients with CIT were more likely to have a history of heart failure, a pre-existing central venous catheter and recent hospitalization [ 9 ] . It is hypothesized that heart failure contributes to CIT because it promotes stasis in the right heart that entraps the CIT.…”

Section: Discussionmentioning

confidence: 99%

Clot In Transit in a Patient with Protein S Deficiency

Kashfi

Nasser

Soleiman

et al. 2022

European Journal of Case Reports in Internal Medicine

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Clot in transit (CIT) is a rare condition in which a venous thromboembolism becomes lodged in the right heart. It is seen in up to 18% of patients with massive pulmonary embolism, and if left untreated, mortality rates are between 80% and 100%. The identification and management of CIT are crucial. However, there are no current guidelines for the treatment of CIT. We present the case of a 44-year-old woman who was found to have CIT that was ultimately treated with medical management.

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“…If CTPA demonstrates right ventricular dilatation, echocardiography may be indicated. Echocardiography is also better suited to evaluate clot in transit, another high‐risk imaging feature 55–58 . High‐risk laboratory values include an elevated troponin 59,60 .…”

Section: Methodsmentioning

confidence: 99%

“…Echocardiography is also better suited to evaluate clot in transit, another high-risk imaging feature. [55][56][57][58] High-risk laboratory values include an elevated troponin. 59,60 Conversely, a negative highsensitivity troponin can support discharge to home, as it has a high negative predictive value for adverse events in patients with acute PE.…”

Section: Clinical Criteria For Outpatient Treatment Of a Patient With...mentioning

confidence: 99%

A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel

et al. 2021

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The outpatient treatment of select emergency department patients with acute pulmonary embolism (PE) or deep vein thrombosis (DVT) has been shown to be safe, cost effective and associated with high patient satisfaction. Despite this, outpatient PE and DVT treatment remains uncommon. To address this, the American College of Emergency Physicians assembled a multidisciplinary team of content experts to provide evidence‐based recommendations and practical advice to help clinicians safely treat patients with low‐risk PE and DVT without hospitalization. The emergency clinician must stratify the patient's risk of clinical decompensation due to their PE or DVT as well as their risk of bleeding due to anticoagulation. The clinician must also select and start an anticoagulant and ensure that the patient has access to the medication in a timely manner. Reliable follow‐up is critical, and the patient must also be educated about signs or symptoms that should prompt a return to the emergency department. To facilitate access to these recommendations, the consensus panel also created 2 web‐based “point‐of‐care tools.”

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Pulmonary embolism with clot in transit: An analysis of risk factors and outcomes

Cited by 16 publications

References 14 publications

Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes

Saddle Pulmonary Embolism: Demographics, Clinical Presentation, and Outcomes

Clot In Transit in a Patient with Protein S Deficiency

A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel

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