Clot In Transit in a Patient with Protein S Deficiency

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. LEARNING POINTS: Clot in transit (CIT) is a dangerous entity that must be promptly managed. Risk factors for CIT include a history of heart failure, a pre-existing central venous catheter and recent hospitalization. New interventions are emerging for the treatment of CIT.