A meta-analysis of outcomes of catheter-directed thrombolysis for high- and intermediate-risk pulmonary embolism

Avgerinos, Efthymios D.; Saadeddin, Zein; Ali, Adham N. Abou; Fish, Larry; Toma, Catalin; Chaer, Maria; Rivera‐Lebron, Belinda; Chaer, Rabih A.

doi:10.1016/j.jvsv.2018.03.010

Cited by 76 publications

(68 citation statements)

References 41 publications

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“…Cohort and registry studies have shown improvement in surrogate outcomes of right ventricular function but no difference in recurrent pulmonary embolism or mortality 15. Major bleeding rates are variable across studies but reported by some to be similar to those with systemic thrombolysis 128129. The role for CTD remains unclear, and we do not recommend its routine use except in experienced centers when a patient has hemodynamic compromise and a high risk of bleeding and therapy can be started without delay.…”

Section: Initial Treatment For Pulmonary Embolismmentioning

confidence: 96%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

146

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Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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Section: Initial Treatment For Pulmonary Embolismmentioning

confidence: 96%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

146

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“…In intermediate risk patients, the clinical success was 95% and 97.5% for CDT and ultrasound CDT, respectively. They concluded that ultrasound CDT may be more effective in high-risk patients [20].…”

Section: Trialmentioning

confidence: 99%

The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism

Khan¹,

Yamamura²,

Vargas³

et al. 2019

Cureus

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Pulmonary embolism has become a cause of great concern to health care professionals. Despite strides in research and availability of sensitive diagnostic tests, the mortality and morbidity related to this entity continues to cause tremendous economic burden. Patients present with an array of symptoms ranging from mild dyspnea to hemodynamic instability and even death. Prompt recognition of symptoms along with early risk stratification can be lifesaving. Management focuses on achieving hemodynamic stability and reducing clot burden. Approved treatment modalities include anticoagulation, systemic or catheter directed thrombolytic therapy and surgical embolectomy. In this article we will review catheter-directed thrombolytic therapy, specifically the EKOS® or the EkoSonic endovascular system. EKOS® uses ultrasoundfacilitated catheter-directed thrombolysis. The rationale behind this therapy is using shorter infusion times and lower dosage of the thrombolytic therapy, thereby reducing the complications associated with their use.

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“…Некоторые врачи обеспокоены, что риски, связанные с процедурой, могут суммироваться с присущим геморрагическим потенциалом тромболитических агентов [30]. Другие рассматривают КУТ как эффективный, минимально инвазивный и безопасный метод лечения для предотвращения клинического ухудшения состояния пациента и для улучшения функции ПЖ [27,31]. Figure 3.…”

Section: тяжести легочной эмболииunclassified

“…Изображение двухсторонних катетеров EKOS, установленных в легочных артериях через доступ правой общей бедренной вены Figure 4. Representative bilateral EKOS-catheters placed in the pulmonary arteries via the right common femoral vein approach анализировались суммарная оценка клинического улучшения, 30-дневная смертность и массивные кровотечения после проведения КУТ и КУТ-УЗ [31]. В группе больных высокого риска суммарная оценка клинического улучшения составила 81,3% (95% доверительный интервал (ДИ), 72,5-89,1), 30-дневная смертность -8% (95% ДИ, 3,2-14,0%) и массивные кровотечения -6,7% (95% ДИ, 1,0-15,3%).…”

Section: тяжести легочной эмболииunclassified

“…Клиническое улучшение в группе больных ЛЭ высокого риска, которым выполнялись КУТ и КУТ-УЗ, было отмечено в 70,8% (95% ДИ, 53,4-85,8%) и 83,1% (95% ДИ, 68,5-94,5%), соответственно. В группе больных промежуточного риска показатели эффективности обеих методик отличались не столь существенно (95% для КУТ и 97,5% для КУТ-УЗ) [31]. Авторы подчеркивают хороший клинический успех КУТ как среди больных ЛЭ высокого, так и промежуточного риска, предостерегая более высокие показатели смертности и массивных геморрагий у пациентов высокого риска.…”

Section: тяжести легочной эмболииunclassified

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The Role of Interventional Methods in Treatment of Pulmonary Embolism

et al. 2018

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The presented review concerns to current interventional methods of acute pulmonary embolism treatment. The article provides a rationale for catheter approaches, detailed description of patient selection and risk stratification including an estimation of thromboembolic burden, risk degree of acute pulmonary embolism, bleeding risk assessment, and patient-specific considerations. The review contains the up-to-date classification of pulmonary embolism on the basis of 30-day mortality assessment and estimation of disease outcome according to the conventional and simplified Pulmonary Embolism Severity Index. A special attention is paid to interventional methods peculiarly, in particular to catheter directed thrombolysis, rheolytic thrombectomy, thrombus fragmentation and aspiration. The results of studies concerning efficiency and safety of endovascular methods in treatment of pulmonary embolism patients are reported. It was emphasized importance of further investigation of various clinical aspects using these methods for obtaining of comprehensive information about treatment of the dangerous disease associated with significant morbidity and mortality.

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A meta-analysis of outcomes of catheter-directed thrombolysis for high- and intermediate-risk pulmonary embolism

Cited by 76 publications

References 41 publications

Pulmonary embolism: update on management and controversies

Pulmonary embolism: update on management and controversies

The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism

The Role of Interventional Methods in Treatment of Pulmonary Embolism

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