Thrombus resolution and right ventricular functional recovery using ultrasound-accelerated thrombolysis in acute massive and submassive pulmonary embolism

Özçınar, Evren; Çakıcı, Mehmet; Yaman, Nur Dikmen; Baran, Çağdaş; Aliyev, Anar; Inan, Bahadir; Durdu, Serkan; Akar, Ahmet; Şırlak, Mustafa

doi:10.23736/s0392-9590.17.03775-0

Cited by 20 publications

(6 citation statements)

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“…Overall, the 1.9% adjusted ICH rate identified in the current real-world analysis is higher than the 0.7% adjusted rate identified in six studies of carefully selected patients who were enrolled in prospective clinical trials. 7,9,[22][23][24][25] The ICH rate of 1.9% reported in the ST population here is similar to that reported in several prior observational and randomized studies of ST. 21,[26][27][28][29] The similar incidence of ICH between ST and CDT, coupled with a higher rate of allcause bleeding in patients receiving CDT in our study, suggest that CDT may not necessarily be a safer modality of thrombolysis compared to ST. The safety of a lower total dose of thrombolytics in CDT compared to ST may be offset by a longer infusion time as well as the invasive nature of the former procedure.…”

Section: Discussionsupporting

confidence: 85%

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Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims

et al. 2020

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Catheter-directed thrombolysis (CDT) and systemic thrombolysis (ST) are used to treat intermediate/high-risk pulmonary embolism (PE) in the absence of comparative safety and effectiveness data. We utilized a large administrative database to perform a comparative safety and effectiveness analysis of catheter-directed versus systemic thrombolysis. From the Optum® Clinformatics® Data Mart private-payer insurance claims database, we identified 100,744 patients hospitalized with PE between 2004 and 2014. We extracted demographic characteristics, high-risk PE features, components of the Elixhauser Comorbidity Index, and outcomes including intracranial hemorrhage (ICH), all-cause bleeding, and mortality among all patients receiving CDT and ST. We used propensity score methods to compare outcomes between matched cohorts adjusted for observed confounders. A total of 1915 patients (1.9%) received either CDT ( n = 632) or ST ( n = 1283). Patients in the CDT group had fewer high-risk features including less shock (5.4 vs 11.1%; p < 0.001) and cardiac arrest (6.8 vs 11.0%; p = 0.004). In 1:1 propensity-matched groups, ICH rates were 1.9% in both the CDT and ST groups ( p = 1.0). All-cause bleeding was higher in the CDT group (15.9 vs 8.7%; p < 0.001), while in-hospital mortality was lower (6.5 vs 10.0%; p = 0.02). Among a nationally representative cohort of patients with PE at higher risk for mortality, CDT was associated with similar ICH rates, increased all-cause bleeding, and lower short and intermediate-term mortality when compared with ST. The competing risks and benefits of CDT in real-world practice suggest the need for large-scale randomized clinical trials with appropriate comparator arms.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims

et al. 2020

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“…), and/or biochemical parameters such as troponin and brain natriuretic peptide. [15,[18][19][20] In the PEITHO study, [18] they showed that changes in systolic blood pressure and respiratory rate were important in the clinical outcome. Güner and his colleagues [19] administered rt-PA in patients with moderate-risk PTE as low doses (25 mg) and slow infusions (6 h), showing statistically significant changes in blood pressure, pulse, respiratory count, and oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

Using Clinical Parameters to Determine the Optimal Dose of Thrombolytic Treatment in Acute Pulmonary Thromboembolism

Uçar¹

2022

Eurasian J Pulmonol

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BACKGROUND AND AIM:The objective of this study was to check if clinical parameters could help us determine the optimal dose of thrombolytic therapy for patients with acute pulmonary thromboembolism (PTE). METHODS: This was a retrospective cohort study. The data were obtained through an examination of medical records and the use of an existing clinical database. A total of 367 individuals admitted to a tertiary care hospital between 2016 and 2019 and diagnosed with PTE were evaluated. The study includes people who had massive or submassive thromboembolism that required thrombolytic therapy. There were two rt-PA dosage groups (100 mg rt-PA and 50 mg rt-PA). RESULTS: A total of 81 patients, 43 females and 38 males, were evaluated. Thirty-one of the patients were administered 100 mg rt-PA and 50 were administered 50 mg rt-PA. The mean age of patients in the 100 mg rt-PA group was 57±18 years, while it was 72±11 years in the 50 mg rt-PA group, with a statistically significant difference of p<0.001. In the malignancy 50 mg rt-PA group, the most frequent risk factors were deep vein thrombosis history 100 mg rt-PA (p=0.54 and p=0.04, respectively). Clinical findings at the time of application were similar in both groups except for systolic blood pressure. Systolic blood pressure was lower in the 50 mg rt-PA group (p=0.03). Especially the change of pulse up to the 60th minute was statistically significant in both 100 mg rt-PA and 50 mg rt-PA groups (p=0.01 and p=0.002, respectively). The change of saturation up to the 60th minute was statistically significant in the 50 mg rt-PA group (p=0.003). CONCLUSIONS: While both 100 mg and 50 mg rt-PA are applied, meaningful activity on clinical parameters is in the first 60 min. In particular, the change in pulse and saturation may be more guiding in the follow-up of treatment effectiveness. The significant improvement of clinical parameters, especially pulse and saturation, in the first hour may suggest that lower dosage rt-PA and lower administration duration may be effective in acute PTE.

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“…[27] There are also important studies on this subject in Turkey. [28][29][30] The significantly lower bleeding risk in patients receiving UACDT is thought to largely to be due to the shortened duration of treatment and smaller total dose of thrombolytic therapy used. A lesser duration of thrombolytic therapy indicates an earlier hemodynamic improvement, which eventually leads to the low mortality rate among patients treated with UACDT.…”

Section: -Catheter-directed Thrombolysismentioning

confidence: 99%

Management of acute pulmonary embolism during COVID-19 pandemic

Aliyev¹

2021

Turk J Vasc Surg

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In late December 2019, COVID-19 was first reported from China, leading to a serious pandemic, and changed the agenda of the world for months. Although data are accumulating from many countries everyday, it is known that the most common reason for hospitalization of COVID-19 patients is severe respiratory distress. Acute pulmonary embolism is an important cause of death in hospitalized patients. Rapid diagnosis and treatment have a vital importance, as the majority of deaths occur with shock within the first few hours after presentation. In this article, we present a summary of COVID-19 pandemic and give an expert opinion report for common problems related to pulmonary thromboembolic disease and treatment modalities during the outbreak.

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Thrombus resolution and right ventricular functional recovery using ultrasound-accelerated thrombolysis in acute massive and submassive pulmonary embolism

Cited by 20 publications

References 0 publications

Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims

Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims

Using Clinical Parameters to Determine the Optimal Dose of Thrombolytic Treatment in Acute Pulmonary Thromboembolism

Management of acute pulmonary embolism during COVID-19 pandemic

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