Catheter-directed, ultrasound-assisted thrombolysis is a safe and effective treatment for pulmonary embolism, even in high-risk patients

Lee, Kristen A.; Cha, Andrew; Kumar, Mark H.; Rezayat, Combiz; Sales, Clifford M.

doi:10.1016/j.jvsv.2016.10.075

Cited by 21 publications

(25 citation statements)

References 11 publications

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“…Once the catheter is embedded in the thrombus, a bolus of 2 to 6 mg of thrombolytic may be given prior to initiation of the infusion. 28 The standard infusion rate is 1 to 2 mg/hour for a single catheter or 0.5 to 1 mg/hour if two catheters are in place. The infusion is done in typically 12 to 24 hours, for a total thrombolytic dose of 15 to 30 mg. 14,15 During the thrombolytic infusion, a subtherapeutic infusion of heparin is concurrently administered, with a partial thromboplastin time goal of 40 to 60 seconds.…”

Section: Techniques and Catheters For Cdtmentioning

confidence: 99%

“…The infusion is done in typically 12 to 24 hours, for a total thrombolytic dose of 15 to 30 mg. 14,15 During the thrombolytic infusion, a subtherapeutic infusion of heparin is concurrently administered, with a partial thromboplastin time goal of 40 to 60 seconds. 28 Notably, there is still significant center-to-center variability in dosing and treatment protocols.…”

Section: Techniques and Catheters For Cdtmentioning

confidence: 99%

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Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Chiarello

Sista

2018

Semin intervent Radiol

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Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis. Three prospective trials have evaluated CDT for submassive PE; ULTIMA, SEATTLE II, and PERFECT. These trials provide evidence that CDT may improve radiographic efficacy endpoints in submassive PE with acceptable rates of major hemorrhage. However, the lack of clinical endpoints, long-term follow-up, and adequate sample size limit their generalizability. Future trials should be adequately powered and controlled so that the short- and long-term effectiveness and safety of CDT can be definitively determined.

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Section: Techniques and Catheters For Cdtmentioning

confidence: 99%

Section: Techniques and Catheters For Cdtmentioning

confidence: 99%

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Chiarello

Sista

2018

Semin intervent Radiol

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“…With this technique, no thoracic surgery, but only angiography is required. Thus, a catheter-directed thrombolysis can be done also in centers without thoracic surgical service or if the patient -as was the case here-is highly unstable and surgery comes at a high risk [5]. The risks of the catheter-directed intervention are low-common side effects are rare and typically affect the vascular access site (e.g.…”

Section: Discussionmentioning

confidence: 90%

“…The risks of the catheter-directed intervention are low-common side effects are rare and typically affect the vascular access site (e.g. haematoma) [5].…”

Section: Discussionmentioning

confidence: 99%

Combined Application of Percutaneous Extracorporeal Lung Assistance System Together with Catheter-Directed Therapy for the Rescue of Massive Pulmonary Embolism after Failed Systemic Thrombolysis

Brandner¹,

Huber²,

Laugwitz³

et al. 2018

J Cardiovasc Med Cardiol

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“…Several reasons can be identified for this higher incidence compared to ± 10% major bleeding in previous literature. Our study population involved patients with high-risk PE only, as opposed to 12–22% with high-risk PE in other studies [ 15 , 16 , 18 , 19 , 24 , 25 ]. Furthermore, our findings are based on real-world data and reflect how current guidelines are put into practice.…”

Section: Discussionmentioning

confidence: 99%

Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

Winter

Hart

Heuvel

et al. 2019

Cardiovasc Intervent Radiol

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Purpose To provide insight into the current use and results of ultrasound-facilitated catheter-directed thrombolysis (USAT) in patients with high-risk pulmonary embolism (PE). Introduction Systemic thrombolysis is an effective treatment for hemodynamically unstable, high-risk PE, but is associated with bleeding complications. USAT is thought to reduce bleeding and is therefore advocated in patients with high-risk PE and contraindications for systemic thrombolysis. Methods We conducted a retrospective cohort study of all patients who underwent USAT for high-risk PE in the Netherlands from 2010 to 2017. Characteristics and outcomes were analyzed. Primary outcomes were major (including intracranial and fatal) bleeding and all-cause mortality after 1 month. Secondary outcomes were all-cause mortality and recurrent venous thromboembolism within 3 months. Results 33 patients underwent USAT for high-risk PE. Major bleeding occurred in 12 patients (36%, 95% CI 22–53), including 1 intracranial and 3 fatal bleeding. All-cause mortality after 1 month was 48% (16/33, 95% CI 31–66). All-cause mortality after 3 months was 50% (16/32, 95% CI 34–66), recurrent venous thromboembolism occurred in 1 patient (1/32, 3%, 95% CI 1–16). Conclusions This study was the first to describe characteristics and outcomes after USAT in a study population of patients with high-risk PE only, an understudied population. Although USAT is considered a relatively safe treatment option, our results illustrate that at least caution is needed in critically ill patients with high-risk PE. Further research in patients with high-risk PE is warranted to guide patient selection.

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Catheter-directed, ultrasound-assisted thrombolysis is a safe and effective treatment for pulmonary embolism, even in high-risk patients

Cited by 21 publications

References 11 publications

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Combined Application of Percutaneous Extracorporeal Lung Assistance System Together with Catheter-Directed Therapy for the Rescue of Massive Pulmonary Embolism after Failed Systemic Thrombolysis

Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

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