scholarly journals Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Nathan L Liang ◽  
Rabih A Chaer ◽  
Luke K Marone ◽  
Michael J Singh ◽  
Michel S Makaroun ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Large Scale ◽  
Acute Pulmonary Embolism ◽  
Treatment Time ◽  
Clinical Success ◽  
Interventional Therapy ◽  
Bleeding Complications ◽  
Intermediate Risk ◽  
Catheter Directed Thrombolysis ◽  
One Year

Objective The hemodynamic benefits of catheter-directed thrombolysis for acute pulmonary embolism have not been clearly defined beyond the periprocedural period. The objective of this study is to report midterm outcomes of catheter-directed thrombolysis for treatment of acute pulmonary embolism. Methods Records of all patients undergoing catheter-directed thrombolysis for high- or intermediate-risk pulmonary embolism were retrospectively reviewed. Endpoints were clinical success, procedure-related complications, mortality, and longitudinal echocardiographic parameter improvement. Results A total of 69 patients underwent catheter-directed thrombolysis (mean age 59 ± 15 y, 56% male). Eleven had high-risk and 58 intermediate-risk pulmonary embolism. Baseline characteristics did not differ by pulmonary embolism subtype. Fifty-two percent of patients underwent ultrasound-assisted thrombolysis, 39% standard catheter-directed thrombolysis, and 9% other interventional therapy; 89.9% had bilateral treatment. Average treatment time was 17.7 ± 11.3 h with average t-Pa dose of 28.5 ± 19.6 mg. The rate of clinical success was 88%. There were two major (3%) and six minor (9%) periprocedural bleeding complications with no strokes. All echocardiographic parameters demonstrated significant improvement at one-year follow-up. Pulmonary embolism-related in-hospital mortality was 3.3%, and estimated survival was 81.2% at one year. Conclusions Catheter-directed thrombolysis is safe and effective for treatment of acute pulmonary embolism, with sustained hemodynamic improvement at one year. Further prospective large-scale studies are needed to determine comparative effectiveness of interventions for acute pulmonary embolism.

scholarly journals Association of risk stratification and mortality outcomes in patients of acute pulmonary embolism

2021 ◽  
Vol 8 (9) ◽  
pp. 1400
Author(s):  
Jit H. Brahmbhatt ◽  
Zeeshan H. Mansuri ◽  
Roopesh R. Singhal
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Signs And Symptoms ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Atypical Chest Pain ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Acute Pulmonary Thromboembolism

Background: To study the association of risk stratification and mortality outcomes of patients with high/intermediate risk acute pulmonary embolism who are given the guideline directed therapy after the diagnosis of pulmonary embolism.Methods: Prospective observational study of demographics, clinical profile, risk stratification, management and outcome of patients presenting with acute pulmonary embolism from October 2019to December 2020. Risk stratification was done as per ESC 2019 guidelines into high and intermediate categories, intermediate category patients were further stratified into intermediate-high and intermediate-low-risks.Results: 100 patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years with 60% being males were included in the study. There were 31 patients in high-risk group, 59 patients in intermediate-high subgroup, 10 patients in intermediate-low subgroup. Echocardiography was done in all patients. Outcome was relatively grave in these subgroups with overall mortality of 56 patients. 49 patients were thrombolysed with rTPA, 27patients with alteplase, 4 patients with streptokinase, 12patients who had contraindication to systemic thrombolysis were subjected to catheter directed thrombolysis and 8 patients were taken up for surgical embolectomy.Conclusions: Pulmonary embolism can present with unexplained dyspnea and atypical chest pain among other signs and symptoms. Early diagnosis, risk stratification and guideline directed prompt management can lead to favorable outcomes however; patients with high and intermediate risk at presentation are associated with higher mortality rate despite GDT.

scholarly journals CATHETER DIRECTED THROMBOLYSIS FOR ACUTE PULMONARY EMBOLISM AMONG ELDERLY PATIENTS. A NATIONWIDE ANALYSIS

2021 ◽  
Vol 77 (18) ◽  
pp. 1847
Author(s):  
Ahmed Elkaryoni ◽  
Mahmoud Salem ◽  
Ain Ejaz ◽  
Sorcha Allen ◽  
Joshua Newman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Acute Pulmonary Embolism ◽  
Catheter Directed Thrombolysis

Catheter-directed thrombolysis versus suction thrombectomy in the management of acute pulmonary embolism

2019 ◽  
Vol 7 (5) ◽  
pp. 623-628 ◽  
Author(s):  
Efthymios D. Avgerinos ◽  
Adham Abou Ali ◽  
Catalin Toma ◽  
Bryan Wu ◽  
Zein Saadeddin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Catheter Directed Thrombolysis

scholarly journals A visualized pulmonary arterial thrombus by using a new  echocardiographic view in an intermediate-risk a cute pulmonary embolism  patient: a case report

2019 ◽  
Author(s):  
Guanyu Mu ◽  
Feixue Li ◽  
Xiaolin Chen ◽  
Bo Zhao ◽  
Guangping Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Normal Blood ◽  
Intermediate Risk ◽  
Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

scholarly journals CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM

2019 ◽  
Vol 9 (5) ◽  
pp. 348-366
Author(s):  
G. G. Taradin ◽  
G. A. Ignatenko ◽  
N. T. Vatutin ◽  
I. V. Kanisheva
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Medical Intervention ◽  
Bleeding Complications ◽  
Current View ◽  
Anticoagulant Treatment ◽  
Thrombolytic Treatment ◽  
Systemic Thrombolysis

The presented review concerns contemporary views on specific aspects of anticoagulant and thrombolytic treatment of venous thromboembolism and mostly of acute pulmonary embolism. Modern classifications of patients with acute pulmonary embolism, based on early mortality risk and severity of thromboembolic event, are reproduced. The importance of multidisciplinary approach to the management of patients with pulmonary embolism with the assistance of cardiologist, intensive care specialist, pulmonologist, thoracic and cardiovascular surgeon, aimed at the management of pulmonary embolism at all stages: from clinical suspicion to the selection and performing of any medical intervention, is emphasized. Anticoagulant treatment with the demonstration of results of major trials, devoted to efficacy and safety evaluation of anticoagulants, is highlighted in details. Moreover, characteristics, basic dosage and dosage scheme of direct (new) oral anticoagulants, including apixaban, rivaroxaban, dabigatran, edoxaban and betrixaban are described in the article. In particular, the management of patients with bleeding complications of anticoagulant treatment and its application in cancer patients, who often have venous thromboembolism, is described. Additionally, modern approaches to systemic thrombolysis with intravenous streptokinase, urokinase and tissue plasminogen activators are presented in this review. The indications, contraindications, results of clinical trials devoted to various regimens of thrombolytic therapy, including treatment of pulmonary embolism by lower doses of fibrinolytic agents, are described.

Pulmonary embolism in acute medicine: a case-based review incorporating latest guidelines in the COVID-19 era

2020 ◽  
Vol 81 (6) ◽  
pp. 1-12 ◽  
Author(s):  
Alexander Stevenson ◽  
Sarah Davis ◽  
Nick Murch
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Severe Disease ◽  
Treatment Options ◽  
Risk Scores ◽  
Pulmonary Vasculature ◽  
Catheter Directed Thrombolysis ◽  
Imaging Results ◽  
Venous Thromboembolic Events

Pulmonary embolism remains an important cause of morbidity and mortality in the UK, particularly following the outbreak of the novel coronavirus 2019 (COVID-19), where those infected have an increased prevalence of venous thromboembolic events. The pathophysiology in COVID-19 patients is thought to relate to a thromboinflammatory state within the pulmonary vasculature, triggered by the infection, but other risk factors such as reduced mobility, prolonged immobilisation and dehydration are likely to contribute. Several societies have released comprehensive guidelines emphasising the importance of risk stratification in patients with acute pulmonary embolism. They advocate the use of clinically validated risk scores in conjunction with biochemical and imaging results. Patients with mild disease can now be managed in the outpatient setting and with newly developed therapies, such as catheter-directed thrombolysis, becoming available in more centres, treatment options for those with more severe disease are also expanding. This article presents four theoretical but realistic cases, each diagnosed with acute pulmonary embolism, but differing in levels of severity. These demonstrate how the guidelines can be applied in a clinical setting, with particular focus on risk stratification and management.

Evaluation of Fibrinogen Levels during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

2020 ◽  
Vol 31 (8) ◽  
pp. 1281-1289 ◽  
Author(s):  
Assaf Graif ◽  
Christopher J. Grilli ◽  
George Kimbiris ◽  
Helen H. Paik ◽  
Daniel A. Leung
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Catheter Directed Thrombolysis
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