Therapeutic advances in cardiovascular disease
Management strategies for right-to-left intraatrial shunt with thrombus in transit: a systematic review of 297 patients and associated mortality outcomes
By Alkhawam M, Simmons J, Ray T and 9 others.
Abstract
Background
Thrombus in transit (TIT) through a patent foramen ovale (PFO) or atrial septal defect (ASD) is a rare but potentially life-threatening condition associated with paradoxical embolism. Despite advances in imaging and interventional techniques, optimal management strategies remain poorly defined.
Objectives
To systematically characterize the clinical presentation, diagnostic approaches, management strategies, and outcomes of adult patients with TIT across right-to-left intra-atrial shunts.
Design
Systematic review of published cases. Data sources and methods: Following PRISMA guidelines, PubMed, Embase, and Scopus were searched from inception through March 2025 for case reports, case series, and letters describing adult patients with TIT visualized by transthoracic or transesophageal echocardiography. After screening 1736 records, 278 studies reporting 297 patients were included. Two independent reviewers extracted demographic, clinical, imaging, treatment, and outcome data. Descriptive statistics were summarized, and treatment groups were compared using chi-square and Mann-Whitney U tests. Kaplan-Meier survival curves with log-rank testing assessed 120-day survival, and multivariable Cox regression was used to evaluate potential predictors of mortality.