Safety and efficacy of ultrasound-accelerated catheter-directed lytic therapy in acute pulmonary embolism with and without hemodynamic instability

Nykamp, Madeline; VandenHull, Angela; Remund, Tyler; Santos, Angelo; Kelly, Patrick; Schultz, Greg; Laurich, Chad

doi:10.1016/j.jvsv.2015.03.001

Cited by 21 publications

(8 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our PERT employed CDT for a large percentage of cases, and we therefore analyzed the effect of CDT on LOS and found no association, in contrast to other studies that found a shorter LOS with CDT. 18,19 We also found no correlation with severity at presentation (assessed by hemodynamics and the sPESI score). In fact, of the risk factors analyzed, only an elevated serum BNP was associated with increased LOS.…”

Section: Discussionmentioning

confidence: 59%

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

et al. 2017

View full text Add to dashboard Cite

Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded. A total of 124 PERT activations occurred over 20 months: 43 in the first 10 months and 81 in the next 10. A total of 87 submassive (90.8%) and massive (9.2%) PE patients were included. The median age was 65 (51-75 IQR) years. Catheter-directed thrombolysis (CDT) was administered to 25 patients, systemic thrombolysis (ST) to six, and anticoagulation alone (AC) to 54. The median ICU stay and overall LOS were 6 (3-10 IQR) and 7 (4-14 IQR) days, respectively, with no association with any variables except a brain natriuretic peptide (BNP) >100 pg/mL ( p=0.008 ICU LOS; p=0.047 overall LOS). Twelve patients (13.7%) died in the hospital, nine of whom had metastatic or brain cancer, with a median overall LOS of 13 (11-17 IQR) days. There were five major bleeds: one in the CDT group, one in the ST group, and three in the AC group. Overall, (1) PERT activations increased after the first 10 months; (2) BNP >100 pg/mL was associated with a longer LOS; (3) rates of mortality and bleeding did not correlate with treatment; and (4) the majority of in-hospital deaths occurred in patients with advanced cancer.

show abstract

Section: Discussionmentioning

confidence: 59%

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The mean age range of the studies was 54–61 years with an average of 60 years and 37–60% was the proportion of male patients (mean 51%). As shown in Table , 21.6% of the patients had a massive PE compared to 78.4% with a submassive PE.…”

Section: Resultsmentioning

confidence: 90%

Safety of catheter‐directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta‐analysis

Bloomer

El-Hayek

McDaniel

et al. 2017

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…While one small single-center study of 45 patients with acute intermediate- or high-risk PE suggested a decreased LOS associated with UACDT from approximately seven days to three days, this finding has not been replicated. 18 Indeed, multiple studies of patients with intermediate-risk PEs have suggested average hospitalization lengths of approximately five days regardless of whether UACDT was employed. 10 , 19 It is worth noting that at our institution all patients who undergo UACDT are observed in an ICU for the duration of thrombolytic infusion.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐assisted catheter‐directed thrombolysis compared with anticoagulation alone for treatment of intermediate‐risk pulmonary embolism

et al. 2018

View full text Add to dashboard Cite

It is unclear if ultrasound-assisted catheter-directed thrombolysis (UACDT) confers benefit over anticoagulation (AC) alone in the management of intermediate-risk (“submassive”) pulmonary embolism (PE), defined by evidence of right ventricular (RV) dysfunction in hemodynamically stable patients. This study sought to evaluate any lasting advantage of UACDT on mortality and resolution of RV dysfunction in intermediate-risk PE at a large academic medical center. Adults aged ≤ 86 years admitted with intermediate-risk PE from 2011 to 2016 were retrospectively identified. Patients were excluded if there was a history of cancer, pre-existing pulmonary hypertension, pregnancy or postpartum status, contraindication to AC, or treatment with systemic thrombolysis. Baseline Pulmonary Embolism Severity Index (PESI) scores were computed. Outcomes including length of stay (LOS), bleeding complications, resolution of RV dysfunction, and mortality were compared between patients who received UACDT and those managed with AC alone. A total of 104 patients met inclusion criteria, 65 of whom underwent UACDT. The cohorts had similar PESI scores (P = 0.45) and no clearly imbalanced confounding variables. There was no significant difference in LOS (P = 0.11). UACDT was associated with more bleeding complications (exact P = 0.04). Follow-up transthoracic echocardiograms performed in 54 UACDT and 24 AC patients demonstrated similar rates of resolution of RV dysfunction (61% in UACDT patients versus 75% in AC patients, P = 0.25). Overall one-year mortality was approximately 5% in both groups (exact P > 0.99). In this limited retrospective analysis of intermediate-risk PE patients, UACDT treatment was not associated with mortality benefit or increased resolution of RV dysfunction.

show abstract

Safety and efficacy of ultrasound-accelerated catheter-directed lytic therapy in acute pulmonary embolism with and without hemodynamic instability

Cited by 21 publications

References 23 publications

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

A pulmonary embolism response team’s initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism

Safety of catheter‐directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta‐analysis

Ultrasound‐assisted catheter‐directed thrombolysis compared with anticoagulation alone for treatment of intermediate‐risk pulmonary embolism

Contact Info

Product

Resources

About