Thrombolysis for pulmonary embolism using the superficial veins of the upper extremity

Kusick, Joseph; Salamat, Judd; Sanghvi, Kintur

doi:10.1002/ccd.27193

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…Both trials used tPA over 12 to 24 h at total doses of 20 to 24 mg for acute pulmonary embolism. More recently, the OPTALYSE PE [10] trial showed that tPA at a lower total doses (4 to 12 mg per lung) and with shorter period infusion duration from 2 to 6 hours had similar results as the previous trials with reduction in right ventricular-to-left ventricular diameter ratio and improvement in the patient's symptoms.…”

Section: Discussionmentioning

confidence: 62%

“…A patient's body habitus, specifically if obese, can impact the accessibility of the femoral or jugular veins, increasing the likelihood of multiple access attempts which in turn will increase the risk for hematoma. By utilizing superficial upper extremity venous access, complications such as hematoma, pseudoaneurysm, AV fistula, and pneumothorax are significantly reduced [10]. In addition, superficial upper extremity venous access for PE thrombolysis is more convenient for the patient with the ability to sit upright, change position, and even stand, making it yet another added benefit compared to the femoral access.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism

Elkhouly¹,

Enos²,

Fox³

2021

Cureus

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Traditionally, massive, life-threatening pulmonary embolism (PE) has been treated with systemic thrombolytic therapy while submassive and smaller acute PEs have been treated with systemic anticoagulation therapy. Given that thrombolytic therapy is associated with the risk of life-threatening complications including intracranial hemorrhage, it has not been routinely used or recommended for submassive PEs. In 2017, the Food and Drug administration (FDA) approved ultrasound-facilitated catheter-directed thrombolysis (USCDT) for acute massive and sub-massive pulmonary embolism. USCDT has primarily been performed using jugular or femoral venous access. There have been isolated reports of USCDT performed through upper extremity venous access. We present a case of USCDT in a submassive PE patient with dual right upper extremity venous access where both sheaths were advanced into the basilic vein (due to anatomic variation). Based on recent clinical trial data suggesting that shorted duration USCDT is as effective as longer duration, tissue plasminogen activator (tPA) was infused in this case for 6 hours. This strategy for intervention can enhance patient comfort with USCDT therapy and can be particularly helpful in patients at high risk for access site complications and those unable to lie supine for the long duration of infusion therapy.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism

Elkhouly¹,

Enos²,

Fox³

2021

Cureus

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“…In one case, USCDT catheters were introduced into the superficial veins of the right upper extremity with bilateral pulmonary artery catheters advanced through the cephalic and basilic veins separately to deliver tPA for 12 h [11].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-facilitated catheter-directed thrombolysis via dual right upper extremity venous access into the basilic vein in a case of submassive pulmonary embolism

Elkhouly

Enos

Fox

2022

gcsp

View full text Add to dashboard Cite

Traditionally, massive, life-threatening pulmonary embolism (PE) has been treated with systemic thrombolytic therapy, whereas submassive and smaller acute PEs have been treated with systemic anticoagulation therapy. Given that thrombolytic therapy is associated with a risk of life-threatening complications, including intracranial hemorrhage, it has not been routinely used or recommended for submassive PEs. In 2017, the Food and Drug Administration (FDA) approved ultrasound-facilitated catheter- directed thrombolysis (USCDT) for acute massive and sub-massive pulmonary embolism. USCDT is primarily performed via jugular or femoral venous access. There have been isolated reports of USCDT performed via upper-extremity venous access. We present a case of ultrasound-facilitated catheter-directed thrombolysis (USCDT) in a submassive PE patient with dual right upper extremity venous access, where both sheaths were advanced into the basilic vein (due to anatomic variation). Based on recent clinical trial data suggesting that shorted duration USCDT is as effective as longer duration, tPA was infused in this case for 6 hours. This intervention strategy can enhance patient comfort with USCDT therapy and can be particularly helpful in patients at high risk of access site complications and those unable to lie supine for a long duration of infusion therapy.

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“…The decision-making process is guided by meticulously evaluating patient-specific characteristics, including age, comorbidities, and bleeding risk. Close collaboration among cardiologists, pulmonologists, and hematologists is crucial to guarantee a thorough evaluation and well-informed judgment on thrombolytic therapy [ 17 ]. To reduce the likelihood of bleeding problems, other additional treatments might be used simultaneously, such as thrombolysis.…”

Section: Reviewmentioning

confidence: 99%

“…These improvements aim to improve the effectiveness of thrombolysis treatment while reducing the related problems. To acknowledge the diversity within the MPE community, future research efforts are expected to investigate customized strategies for distinct subgroups [ 17 ]. Patient characteristics, including age, comorbidities, and the size and location of thrombi, may guide the selection of thrombolytic therapy or alternative interventions.…”

Section: Reviewmentioning

confidence: 99%

Thrombolysis vs Anticoagulation: Unveiling the Trade-Offs in Massive Pulmonary Embolism

Mohamad,

Kanaan,

Ogieuhi

et al. 2024

Cureus

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Massive pulmonary embolism (MPE) is a severe form of venous thromboembolism (VTE) wherein enormous blood clots block the pulmonary arteries, resulting in substantial illness and death. Even with the progress made in diagnostic methods and treatments, the most effective approach for managing MPE is still a topic of considerable discussion. This study examines the delicate equilibrium between thrombolysis and anticoagulation in managing the problematic clinical situation posed by MPE, elucidating the compromises linked to each strategy. The genesis of MPE lies in the pathophysiology of VTE, when blood clots that originate from deep veins in the lower legs or pelvis move to the pulmonary vasculature, leading to an abrupt blockage. This obstruction leads to a series of hemodynamic alterations, such as elevated pulmonary vascular resistance, strain on the right ventricle, and compromised cardiac output, finally resulting in cardiovascular collapse. The seriousness of MPE is commonly categorized according to hemodynamic stability, with significant cases presenting immediate risks to patient survival. Traditionally, heparin has been the primary approach to managing MPE to prevent the spread of blood clots and their movement to other parts of the body. Nevertheless, there have been ongoing discussions regarding the effectiveness of thrombolysis, which entails the immediate delivery of fibrinolytic drugs to remove the blood clot. The use of thrombolysis in managing MPE is being reconsidered because of concerns over bleeding complications and long-term results despite its capacity to resolve the blocking clot quickly. This review rigorously analyzes the current body of evidence, exploring the intricacies of thrombolysis and anticoagulation in MPE. The focus is on evaluating the risk-benefit balance of each treatment option, considering aspects such as the patient's other medical conditions, hemodynamic stability, and potential long-term consequences. This review aims to clarify the complexities of the thrombolysis versus anticoagulation dilemma. It seeks to provide clinicians, researchers, and policymakers with a thorough understanding of the trade-offs in managing MPE. The goal is to facilitate informed decision-making and enhance patient outcomes.

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Thrombolysis for pulmonary embolism using the superficial veins of the upper extremity

Cited by 3 publications

References 7 publications

Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism

Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism

Ultrasound-facilitated catheter-directed thrombolysis via dual right upper extremity venous access into the basilic vein in a case of submassive pulmonary embolism

Thrombolysis vs Anticoagulation: Unveiling the Trade-Offs in Massive Pulmonary Embolism

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