P1622Catheter directed thrombolysis and mechanical thrombectomy in submassive pulmonary embolism

Abstract

Pulmonary embolism: risk-adjusted management / Pregnancy in women with congenital heart disease, foetal cardiology and imaging 349lated to VTE or whether NLR can be a surrogate marker of VTE development after TKR. Purpose: In this study, we examined how many VTE events occur and whether preoperative NLR have a predictive value for VTE in patients taken thromboprophylaxis after TKR surgery. Methods: We retrospectively enrolled 234 patients undergoing TKR surgery. The biochemical tests were performed within 2 weeks prior to surgery and the neutrophil lymphocyte ratio (NLR) was defined as the absolute neutrophil count divided by lymphocyte count in peripheral blood. Low molecular heparin was started 12-24 h after surgery and continued for 10-15 days in all the patients. The enhanced pulmonary artery and lower extremity venography CT scan was routinely performed in all patients at post-operative 5 days. Results: Among of 234 patients, 93 patients (39.7%) were diagnosed as deep vein thrombosis or pulmonary embolism on CT scan. There were no significant differences in terms of age, gender, proportion of one-stage bilateral TKR, indication of TKR, hypertension, diabetes, dyslipidemia and atrial fibrillation between both groups with or without VTE. However, VTE group had higher mean NLR value than group without VTE (2.71±1.77 vs 2.15±1.13, p=0.004). By ROC curve analysis of NLR, NLR cut-off value at 1.90 showed sensitivity 60.2% and specificity 55.3% for prediction of VTE in patients undergoing TKR surgery (area under curve: 0.595, confidence interval: 0.519-0.670, p=0.014). In addition, multivariate regression analysis showed high NLR (NLR value ≥1.90) was a solely independent predictor of VTE after adjusting to age, gender, one-stage bilateral TKR, hypertension, diabetes and dyslipidemia. Conclusion: Our study shows a higher incidence of VTE (39.7%) after TKR in patients with thromboprophylaxis than that of previous studies. Furthermore, mean neutrophil lymphocyte ratio (NLR) was significantly higher in patients with VTE and high NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for prediction of VTE in patients undergoing TKR surgery. Introduction: Percutaneous thrombectomy and catheter directed thrombolysis (CDT) represent well established techniques for the treatment of submassive pulmonary embolism (SPE). The purpose of CDT is to dissolve thrombus in the main and distal pulmonary branch. Methods: Clinical, interventional and echocardiographic data from 72 consecutive patients with SPE who were treated with CDT were evaluated. Diagnosis was made by transthoracal ultrasound and computer tomography. Primary end-points were: technical success, major cardiac and cerebral events (MACCE) and invasive pulmonary pressure. Secondary end-points: rate of procedural and access site complications. The access site for CDT was the femoral vein. CDT was done with Alteplase (10 mg bolus and 1 mg/h maintenance dose) over a pig-tail catheter for 24 hours. After 24 hours, cont...