Abstract Number: PB0296
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: The prothrombotic state of COVID-19 infection is well documented, but recommendations for management of clot in transit in the post-partum state are lacking.
Aims: We describe a unique case of a 39-year-old female, 34-week gravida with pregnancy complicated by COVID-19 and clot in transit.
Methods: Our patient presented to our hospital for a week of worsening dyspnea, cough, and fevers. Given her respiratory decline, she underwent urgent cesarean delivery of a healthy male infant. Initial chest x-ray was consistent with severe COVID-19 pneumonia. Non-invasive methods of oxygenation were exhausted, and she was eventually intubated. Troponin was <0.02ng/mL, BNP was 71pg/mL, and D-Dimer increased from 601 to 13,000ng/mL. Transthoracic echocardiogram showed preserved cardiac function, but imaging was sub-optimal for the right ventricle (RV). On post-cesarean day 6, CT Pulmonary Angiogram (CTPA) showed bilateral segmental and subsegmental Pulmonary Embolism (PE) with filling defect in the RV consistent with clot in transit (CIT). No RV strain was noted on Echo or CTPA. Lower extremity venous duplex showed only acute calf thrombus. She was anticoagulated with enoxaparin at 1mg/kg, but her oxygen requirements worsened requiring 100% FiO2 on the ventilator. Emergent multidisciplinary discussion was held by PE Response Team (PERT) regarding use of catheter directed lysis, systemic lysis, ECMO or surgical embolectomy.
Results: 
CTPA axial view of thrombus in right ventricle
PERT team ultimately recommended 50mg alteplase be given systemically with family’s consent. After alteplase was given, her oxygen requirements quickly improved to 45% FiO2 and her vitals remained normal. CT Head reported no hemorrhage, and repeat CTPA showed near-complete resolution of RV thrombus.
Conclusions: This case exemplifies the role of both emergent multidisciplinary decision-making in complex case scenarios, and systemic thrombolysis for the management of COVID-19 related CIT in patients who recently underwent cesarean delivery.
To cite this abstract in AMA style:
Peruri A, Kadl A, Ennen C, Wilkins L, Ramcharitar R, Teman N, Sharma A, Mihalek A, Man L. Management of Clot in Transit in a Postpartum COVID-19 Patient [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/management-of-clot-in-transit-in-a-postpartum-covid-19-patient/. Accessed December 11, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-clot-in-transit-in-a-postpartum-covid-19-patient/