Abstract: SA-PO970
Catheter-Related Right Atrial Thrombus on Hemodialysis Patients: Results of a Cohort Study
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Gómez Ruiz, Ismael Antonio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
- Porto-Silva, Lucas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
- Vazquez ortiz, Zuilma, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
- Galindo uribe, Jaime, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
- Correa-Rotter, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
- Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, DISTRITO FEDERAL, Mexico
Background
Catheter-induced right atrial thrombus (CRAT) is a serious complication in hemodialysis (HD) patients and optimal treatment is not well defined. We reviewed clinical characteristics, treatments options, and outcomes of CRAT in HD patients
Methods
Single-center retrospective cohort study of CRAT confirmed by echocardiogram (2008-2018).
Results
We identified 23 CRAT cases in HD. Thrombus was visualized initially by transthoracic echocardiogram in 74% (17/23); all but one had transesophageal echocardiogram. The largest thrombus dimension was 52x23 mm. Factors related to CRAT were long catheter vintage (7 [IQR 4-13] months) and catheter misplacement in 65% (15/23). All cases received anticoagulation as initial treatment. The most relevant clinical data for subsequent treatment decision was suspicion of catheter-related bloodstream infection (CRBSI). Patients were divided in those that had early catheter removal due CRBSI (39%, 9/23) and those who had non-urgent indication of catheter removal (61%,14/23) [Table]. Early removal group had worse outcomes:100% had catheter removal before therapeutic anticoagulation was achieved, 44% had embolic complications after catheter removal, 78% required surgical definitive treatment, and 44% (4/9) died. Non-urgent catheter removal group received total anticoagulation for 22 [IQR 13-28] weeks, dissolution of thrombus occurred in 64% (9/14), thrombus shrinking in 14% and 42% required delayed catheter removal without major adverse events.
Conclusion
To our knowledge, this is the first large cohort of CRAT on HD. Total anticoagulation is essential after CRAT diagnosis and may be sufficient to dissolve or shrink thrombus <52 mm in asymptomatic or stable febrile HD patients without an urgent indication for catheter removal. Infection related to CRAT had a high risk of adverse outcomes, including mortality.
Characteristics of the HD cohort and clinical outcomes.
| All CRAT(n=23) | Urgent catheter removal (n=9) | Non-urgent catheter removal (n=14) | p value | |
| Age (years) Female (n) | 41±16 16 (67%) | 45±19 8 (89%) | 38±13 8 (57%) | 0.26 0.12 |
| Fever Dialysis vintage, mo | 14 (61%) 16 [7-39] | 9 (100%) 9 [4-36] | 5 (36%) 19 [12-47] | 0.002 0.37 |
| Median maximum thrombus diameter, mm | 23 [16-29] | 25 [23-40] | 19 [15-27] | 0.096 |
| Successful thrombus dissolution or shrinking with OACs | 11 (47%) | 0 (0%) | 11 (78%) | <0.001 |
| Embolic complications Cardiac surgery as final treatment | 5 (22%) 7(30%) | 5 (36%) 7 (50%) | 0 (0%) 0 (0%) | 0.0037 <0.001 |
| Deaths, n | 5 (22%) | 4 (29%) | 1 (11%)* | 0.056 |
*Death not directly related to CRAT event