Rolf P Engelberger1, Aris Moschovitis2, Jennifer Fahrni1, Torsten Willenberg1, Frederic Baumann1, Nicolas Diehm1, Do-Dai Do1, Iris Baumgartner1, Nils Kucher3. 1. Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland. 2. Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital-University Hospital and University of Bern, Bern, Switzerland. 3. Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital-University Hospital and University of Bern, Bern, Switzerland nils.kucher@insel.ch.
Abstract
AIMS: No standardized local thrombolysis regimen exists for the treatment of pulmonary embolism (PE). We retrospectively investigated efficacy and safety of fixed low-dose ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk PE. METHODS AND RESULTS: Fifty-two patients (65 ± 14 years) of whom 14 had high-risk PE (troponin positive in all) and 38 intermediate-risk PE (troponin positive in 91%) were treated with intravenous unfractionated heparin and USAT using 10 mg of recombinant tissue plasminogen activator per device over the course of 15 h. Bilateral USAT was performed in 83% of patients. During 3-month follow-up, two [3.8%; 95% confidence interval (CI) 0.5-13%] patients died (one from cardiogenic shock and one from recurrent PE). Major non-fatal bleeding occurred in two (3.8%; 95% CI, 0.5-13%) patients: one intrathoracic bleeding after cardiopulmonary resuscitation requiring transfusion, one intrapulmonary bleeding requiring lobectomy. Mean pulmonary artery pressure decreased from 37 ± 9 mmHg at baseline to 25 ± 8 mmHg at 15 h (P < 0.001) and cardiac index increased from 2.0 ± 0.7 to 2.7 ± 0.9 L/min/m(2) (P < 0.001). Echocardiographic right-to-left ventricular end-diastolic dimension ratio decreased from 1.42 ± 0.21 at baseline to 1.06 ± 0.23 at 24 h (n = 21; P < 0.001). The greatest haemodynamic benefit from USAT was found in patients with high-risk PE and in those with symptom duration < 14 days. CONCLUSION: A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: No standardized local thrombolysis regimen exists for the treatment of pulmonary embolism (PE). We retrospectively investigated efficacy and safety of fixed low-dose ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk PE. METHODS AND RESULTS: Fifty-two patients (65 ± 14 years) of whom 14 had high-risk PE (troponin positive in all) and 38 intermediate-risk PE (troponin positive in 91%) were treated with intravenous unfractionated heparin and USAT using 10 mg of recombinant tissue plasminogen activator per device over the course of 15 h. Bilateral USAT was performed in 83% of patients. During 3-month follow-up, two [3.8%; 95% confidence interval (CI) 0.5-13%] patients died (one from cardiogenic shock and one from recurrent PE). Major non-fatal bleeding occurred in two (3.8%; 95% CI, 0.5-13%) patients: one intrathoracic bleeding after cardiopulmonary resuscitation requiring transfusion, one intrapulmonary bleeding requiring lobectomy. Mean pulmonary artery pressure decreased from 37 ± 9 mmHg at baseline to 25 ± 8 mmHg at 15 h (P < 0.001) and cardiac index increased from 2.0 ± 0.7 to 2.7 ± 0.9 L/min/m(2) (P < 0.001). Echocardiographic right-to-left ventricular end-diastolic dimension ratio decreased from 1.42 ± 0.21 at baseline to 1.06 ± 0.23 at 24 h (n = 21; P < 0.001). The greatest haemodynamic benefit from USAT was found in patients with high-risk PE and in those with symptom duration < 14 days. CONCLUSION: A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Ahmed K Pasha; Muhammad Umer Siddiqui; Muhammad Danial Siddiqui; Adnan Ahmed; Ammar Abdullah; Irbaz Riaz; M Hassan Murad; Haraldur Bjarnason; Waldemar E Wysokinski; Robert D McBane Journal: J Thromb Thrombolysis Date: 2021-08-31 Impact factor: 2.300
Authors: Efthymios D Avgerinos; Adham N Abou Ali; Nathan L Liang; Belinda Rivera-Lebron; Catalin Toma; Robert Maholic; Michel S Makaroun; Rabih A Chaer Journal: J Vasc Surg Venous Lymphat Disord Date: 2018-03-31
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