Pharmacomechanical Thrombolysis of Experimental Pulmonary Emboli

Tapson, Victor F.; Gurbel, Paul A.; Witty, Lynn A.; Pieper, Karen S.; Stack, Richard S.

doi:10.1378/chest.106.5.1558

Cited by 44 publications

(18 citation statements)

References 18 publications

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“…Catheter‐directed thrombolysis (CDT) has evolved as an alternative strategy for patients with high bleeding risk. Use of CDT is associated with more rapid permeation of the thrombolytic agent allowing shorter infusion times. This coupled with local intraclot delivery of thrombolytic agent is postulated to result in lower bleeding complications .…”

Section: Introductionmentioning

confidence: 99%

Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis

Patel

Agnihotri

et al. 2015

Cathet Cardio Intervent

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Objective: The aim of the study was to assess the utilization of catheter-directed thrombolysis (CDT) and its comparative effectiveness against systemic thrombolysis in acute pulmonary embolism (PE). Background: Contemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse. Methods: We queried the Nationwide Inpatient Sample from 2010 to 2012 using the ICD-9-CM diagnosis code 415.11, 415.13, and 415.19 for acute PE. We used propensity score analysis to compare outcomes between systemic thrombolysis and CDT. Primary outcome was in-hospital mortality. Secondary outcome was combined in-hospital mortality and intracranial hemorrhage (ICH). Results: Out of 110,731 patients hospitalized with PE, we identified 1,521 patients treated with thrombolysis, of which 1,169 patients received systemic thrombolysis and 352 patients received CDT. After propensitymatched comparison, primary and secondary outcomes were significantly lower in the CDT group compared to systemic thrombolysis (21.81% vs. 13.36%, OR 0.55, 95% CI Additional Supporting Information may be found in the online version of this article. 86:1219-1227 (2015) 0.36-0.85, P value 5 0.007) and (22.89% vs. 13.36%, OR 0.52, 95% CI 0.34-0.80, P value 5 0.003), respectively. The median length of stay [7 days, interquartile range (IQR) (5-9 days) vs. 7 days, IQR (5-10 days), P 5 0.17] was not significant between the two groups. The CDT group had higher cost of hospitalization [$17,218, IQR ($12,906) vs. $23,799, IQR ($17,338), P < 0.001]. Multivariate analysis identified increasing age, saddle PE, cardiopulmonary arrest, and Medicaid insurance as independent predictors of in-hospital mortality. Conclusions: CDT was associated with lower in-hospital mortality and combined in-hospital mortality and ICH. V C 2015 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions

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Section: Introductionmentioning

confidence: 99%

Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis

Patel

Agnihotri

et al. 2015

Cathet Cardio Intervent

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“…Alcune tecniche sono state applicate sia in modelli animali sia nell'uomo, con trombolisi aumentate 22,23 . Dosi più basse rispetto a quelle convenzionali di t-Pa od urochinasi sono distribuite per mezzo di un catetere inserito direttamente negli emboli massivi per 10-20 minuti 24,25 . Combinare la terapia trombolitica a distribuzione diretta (a basse dosi) con i possibili benefici meccanismi potrebbe dimostrarsi vantaggioso rispetto alla somministrazione per via endovenosa, specialmente in situazioni in cui la terapia trombolitica è controindicata.…”

Section: Discussioneunclassified

Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

et al. 2010

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Una donna di 71 anni giungeva in Pronto Soccorso alle ore 10,23 in seguito alla comparsa, dal giorno precedente, di dispnea da sforzo progressivamente ingravescente, seguita da dispnea a riposo ed associata ad almeno due episodi lipotimici. La paziente negava ogni altro sintomo. A domicilio, pur in assenza di dolore toracico, di una valutazione dei valori di pressione arteriosa e di indicazione medica, la paziente avrebbe assunto, a distanza di alcuni minuti, due compresse di trinitrina sublinguale ma, vista la persistenza del sintomo, decideva di recarsi in Pronto Soccorso. La valutazione di triage attribuiva alla paziente un codice rosso; la paziente si presentava vigile, orientata, modestamente dispnoica a riposo, pallida. La misurazione dei parametri vitali evidenziava:• PA 95/69; • FC 120 r;• SO 2 in aria 94%.La paziente accedeva immediatamente alla sala di visita dove emergeva, dall'anamnesi remota, unicamente una storia di ipertensione arteriosa pluriennale, unico fattore di rischio per cardiopatia ischemica e per cui la paziente assumeva amlodipina 5 mg, candesartan 16 mg/idroclortiazide 12,5 mg; assumeva anche acido acetilsalicilico 100 mg. Cinque mesi prima, in seguito al manifestarsi di un episodio di dolore toracico, la paziente era stata sottoposta ambulatorialmente ad elettrocardiogramma (ECG), ecocardiogramma, ECG secondo Holter e prova da sforzo, risultati negativi. All'esame obiettivo non erano presenti edemi declivi, segni apparenti di tromboflebiti in atto, turgore giugulare. All'auscultazione del torace era presente un murmure vescicolare fisiologico su tutto l'ambito bilateralmente; l'azione cardiaca appare ritmica, tachicardica, i toni puri con pause libere. Priva di reperti patologici la valutazione dell'addome. La paziente veniva sottoposta a prelievo ematico per esami urgenti, con posizionamento di accesso

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“…Unless the thrombus is fragmented to allow a greater embolic surface area to the lytic drug's effect, thrombolytic infusion into the pulmonary artery proximal to the embolus will be no more efficacious than systemic delivery as it tends to rapidly wash into nonoccluded arteries. 19,22,24,25 The AngioJet Rheolytic Thrombectomy System (Bayer HealthCare, Medrad Inc, Indianola, Pa) provides pharmacomechanical thrombolysis and has been used in the past for PE, with several adverse events reported. Despite a recent study advocating its use in the setting of massive PE, it should probably by avoided.…”

Section: Technical Considerationsmentioning

confidence: 99%

Catheter-directed interventions for acute pulmonary embolism

Avgerinos

Chaer

2015

Journal of Vascular Surgery

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Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality. Systemic anticoagulation is the standard of care, and treatment can be escalated in the setting of massive or submassive PE, given the high mortality risk. A secondary consideration for intervention is the prevention of late-onset chronic thromboembolic pulmonary hypertension. Treatment options include systemic thrombolysis, catheter-directed interventions, and surgical thromboembolectomy. Whereas systemic thrombolysis seems to be beneficial in the setting of massive PE, it appears to be associated with a higher rate of major complications compared with catheter-directed thrombolysis as shown in recent randomized trials for submassive PE. The hemodynamic and clinical outcomes continue to be defined to determine the indications for and benefits of intervention. The current review summarizes contemporary evidence on the role and outcomes of catheter-directed therapies in the treatment of acute massive and submassive PE.

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Pharmacomechanical Thrombolysis of Experimental Pulmonary Emboli

Cited by 44 publications

References 18 publications

Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis

Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis

Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

Catheter-directed interventions for acute pulmonary embolism

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