Catheter Thrombolysis for Pulmonary Embolism | Journal Scan

Study Questions:

What is the safety and effectiveness of catheter-directed therapy (CDT) as an alternative treatment for acute pulmonary embolism (PE)?

Methods:

The investigators enrolled 101 consecutive patients receiving CDT for acute PE in a multicenter registry. Massive PE (n = 28) and submassive PE (n = 73) were treated with immediate catheter-directed mechanical or pharmacomechanical thrombectomy and/or catheter-directed thrombolysis via low-dose hourly drug infusion with tissue plasminogen activator (tPA) or urokinase. Clinical success was defined as meeting all criteria: stabilization of hemodynamics, improvement in pulmonary hypertension and/or right heart strain, and survival to hospital discharge. Primary safety outcomes were major procedure-related complications and major bleeding events.

Results:

There were 53 men and 48 women with average age of 60 years (range, 22-86 years) and mean body mass index of 31.03 ± 7.20 kg/m2. The average thrombolytic doses were 28.0 ± 11 mg tPA (n = 76) and 2,697,101 ± 936,287 IU for urokinase (n = 23). Clinical success was achieved in 24/28 (85.7%) (95% confidence interval [CI], 67.3%-96.0%) patients with massive PE and 71/73 (97.3%) (95% CI, 90.5%-99.7%) with submassive PE. The mean pulmonary artery pressure improved from 51.17 ± 14.06 mm Hg to 37.23 ± 15.81 mm Hg (n = 92; p < 0.0001). Among patients monitored with follow-up echocardiography, 57/64 (89.1%) (95% CI, 78.8%-95.5%; p < 0.0001) showed improvement in right heart strain. There were no major procedure-related complications, no major hemorrhages, and no hemorrhagic strokes.

Conclusions:

The authors concluded that CDT improves clinical outcomes in acute PE patients while minimizing the risk of major bleeding.

Perspective:

This multicenter PE registry reports clinical safety and effectiveness of CDT in a real-world population suffering from acute PE. These data appear to support an optimal CDT protocol of rapid clot debulking for massive PE, while avoiding the AngioJet device to minimize procedure-related complications. Additional prospective randomized studies examining the impact of CDT and low-dose catheter-directed thrombolysis on clinical outcomes of long-term quality of life are indicated.

Clinical Topics: Cardiac Surgery, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Cardiac Surgery and Heart Failure, Lipid Metabolism, Novel Agents, Pulmonary Hypertension, Interventions and Imaging, Interventions and Vascular Medicine, Echocardiography/Ultrasound

Keywords: Echocardiography, Stress, Fibrinolytic Agents, Hemodynamics, Hypertension, Pulmonary, Prospective Studies, Pulmonary Artery, Pulmonary Embolism, Quality of Life, Registries, Stroke, Thrombectomy, Tissue Plasminogen Activator, Urokinase-Type Plasminogen Activator


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