Systemic Thrombolysis Compared to Catheter Directed Thrombolysis in Acute Pulmonary Embolism

Abstract Systemic thrombolysis for acute pulmonary embolism (PE) reduces the risk of death and cardiovascular collapse but is associated with an increased rate of bleeding. The desire to minimize the risk of bleeding events has driven the development of catheter-based strategies for pulmonary reperfusion in PE. These catheter-based strategies utilize lower-dose fibrinolytic regimens or purely mechanical techniques to expedite removal of the embolus. Several devices providing mechanical or suction embolectomy and catheter-directed thrombolysis, with or without facilitation by ultrasound, have been tested. Data are inconsistent regarding the efficacy and safety of mechanical and suction embolectomy. The most comprehensive data on catheter-based techniques stem from trials of ultrasound-facilitated catheter fibrinolysis. Ultrasound-facilitated catheter fibrinolysis relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial haemorrhage than historical rates with systemic fibrinolysis. However, further research is required to determine the optimal application of ultrasound-facilitated catheter fibrinolysis and other catheter-based therapies in patients with acute PE.

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

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213244 ◽

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.

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Temporal Analysis of Tachycardia During Catheter Directed Thrombolysis for Acute Pulmonary Embolism

Vascular and Endovascular Surgery ◽

10.1177/15385744211017109 ◽

2021 ◽

pp. 153857442110171

Author(s):

Assaf Graif ◽

Christopher J. Grilli ◽

Amanda L. Scott ◽

Keval D. Patel ◽

Trelawny J. Zimmermann ◽

...

Keyword(s):

Heart Rate ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Sinus Tachycardia ◽

Retrospective Chart Review ◽

Temporal Analysis ◽

Blocker Therapy ◽

Systemic Thrombolysis ◽

Catheter Directed Thrombolysis ◽

Sustained Reduction

Purpose: To evaluate the effect of catheter directed thrombolysis (CDT) on heart rate (HR) in patients with sinus tachycardia and acute pulmonary embolism (PE). Methods: A retrospective chart review was performed for patients who underwent CDT with tPA for acute massive or submassive PE between 12/2009 and 2/2020. Included were patients who presented with tachycardia at the time of initiation of CDT. Patients with chronic PE, atrial fibrillation, beta blocker therapy, adjunctive endovascular therapy, systemic thrombolysis, or who expired before conclusion of CDT were excluded. HR was measured approximately every hour during CDT. Graphs were plotted of HR as a function of CDT duration. Two interventional radiologists identified the point of plateau (POP) on the graph where CDT had maximized its benefit in decreasing the patient’s HR. Discrepancies were adjudicated by a third interventional radiologist and the median of the 3 measurements was selected. The primary endpoint was the duration of CDT from initiation until the POP. Results: 48 patients were included (52.5 ± 14.7 years, 56.3% female). The POP occurred after 13.1 ± 6.1 hours, by which point HR had been reduced from 110 ± 9.2 bpm to 88 ± 10.6 bpm. Sinus tachycardia was not resolved in 10 patients even though they achieved maximal improvement in HR after 11.3 ± 6.7 hours. Conclusion: Patients presenting with sinus tachycardia related to acute PE achieved maximal, sustained reduction in heart rate from CDT, after approximately 13 hours of infusion. Patients who did not resolve their tachycardia by that point in time were unlikely to resolve it by the conclusion of CDT.

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Low Dose Catheter Directed Thrombolysis for Acute Pulmonary Embolism

Case Medical Research ◽

10.31525/ct1-nct03854266 ◽

2019 ◽

Author(s):

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Low Dose ◽

Catheter Directed Thrombolysis

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

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03203-4 ◽

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

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Comparison of Catheter-Directed Thrombolysis vs Systemic Thrombolysis in Pulmonary Embolism: A Propensity Score Match Analysis

CHEST Journal ◽

10.1016/j.chest.2017.08.1080 ◽

2017 ◽

Vol 152 (4) ◽

pp. A1047 ◽

Cited By ~ 1

Author(s):

Abhishek Mishra ◽

Sukriti Kamboj ◽

Purav Shah ◽

Harshil Shah ◽

Shilkumar Arora ◽

...

Keyword(s):

Pulmonary Embolism ◽

Propensity Score ◽

Propensity Score Match ◽

Match Analysis ◽

Systemic Thrombolysis ◽

Catheter Directed Thrombolysis ◽

Propensity Score Match Analysis

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Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES)

European Respiratory Journal ◽

10.1183/13993003.02963-2020 ◽

2021 ◽

pp. 2002963

Author(s):

Zhenguo Zhai ◽

Dingyi Wang ◽

Jieping Lei ◽

Yuanhua Yang ◽

Xiaomao Xu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Severity Index ◽

Disease Diagnosis ◽

Initial Therapy ◽

European Respiratory Society ◽

Systemic Thrombolysis ◽

All Cause Mortality

BackgroundSimilar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.ObjectivesWe retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).MethodsAdult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.ResultsAmong overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.ConclusionsThe considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

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

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2018.10.025 ◽

2019 ◽

Vol 7 (5) ◽

pp. 623-628 ◽

Cited By ~ 1

Author(s):

Efthymios D. Avgerinos ◽

Adham Abou Ali ◽

Catalin Toma ◽

Bryan Wu ◽

Zein Saadeddin ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Catheter Directed Thrombolysis

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CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-5-348-366 ◽

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.

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