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Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Engelberger, Rolf Peter Moschovitis, Aris Fahrni, Jennifer Willenberg, Torsten Baumann, Frederic A. Diehm, Nicolas Do, Do-Dai Baumgartner, Iris Kucher, Nils |
| Copyright Year | 2015 |
| Abstract | AIMS No standardized local thrombolysis regimen exists for the treatment of pulmonary embolism (PE). We retrospectively investigated efficacy and safety of fixed low-dose ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk PE. METHODS AND RESULTS Fifty-two patients (65 ± 14 years) of whom 14 had high-risk PE (troponin positive in all) and 38 intermediate-risk PE (troponin positive in 91%) were treated with intravenous unfractionated heparin and USAT using 10 mg of recombinant tissue plasminogen activator per device over the course of 15 h. Bilateral USAT was performed in 83% of patients. During 3-month follow-up, two [3.8%; 95% confidence interval (CI) 0.5-13%] patients died (one from cardiogenic shock and one from recurrent PE). Major non-fatal bleeding occurred in two (3.8%; 95% CI, 0.5-13%) patients: one intrathoracic bleeding after cardiopulmonary resuscitation requiring transfusion, one intrapulmonary bleeding requiring lobectomy. Mean pulmonary artery pressure decreased from 37 ± 9 mmHg at baseline to 25 ± 8 mmHg at 15 h (P < 0.001) and cardiac index increased from 2.0 ± 0.7 to 2.7 ± 0.9 L/min/m(2) (P < 0.001). Echocardiographic right-to-left ventricular end-diastolic dimension ratio decreased from 1.42 ± 0.21 at baseline to 1.06 ± 0.23 at 24 h (n = 21; P < 0.001). The greatest haemodynamic benefit from USAT was found in patients with high-risk PE and in those with symptom duration < 14 days. CONCLUSION A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality. |
| Starting Page | 597 |
| Ending Page | 604 |
| Page Count | 8 |
| File Format | PDF HTM / HTML |
| DOI | 10.1093/eurheartj/eht531 |
| PubMed reference number | 24334719 |
| Journal | Medline |
| Volume Number | 36 |
| Issue Number | 10 |
| Alternate Webpage(s) | http://academicdepartments.musc.edu/medicine/divisions/pulmonary/fellowship_and_education/conferences/eurheartj.eht531.full.pdf |
| Alternate Webpage(s) | https://boris.unibe.ch/48870/1/eht531.pdf |
| Alternate Webpage(s) | https://doi.org/10.1093/eurheartj%2Feht531 |
| Journal | European heart journal |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
