TY - JOUR
T1 - High Intermediate Risk Pulmonary Embolism
T2 - The Use of Very Low Dose Catheter-Directed Ultrasound- Accelerated Thrombolysis
AU - Greenspon, Lee W.
AU - Reber, Ryan D.
AU - Desai, Ravi
AU - Plush, Theodore J.
AU - Hegewald, Matthew
AU - Rochani, Haresh
AU - Villas, Peter A.
AU - Bonn, Joseph
PY - 2021/8/12
Y1 - 2021/8/12
N2 - Objective: To determine the hemodynamic benefit, clot burden reduction and safety utilizing an ultra-low dose of Tissue Plasminogen Activator (TPA) with Catheter directed Ultrasound accelerated thrombolysis (USAT) in the management of high Intermediate Risk Pulmonary Embolism. Design: Retrospective, observational case series. Setting: Single Center Academic Community Hospital. Patients: Fifty-two consecutive patients (27 males) with high Intermediate Risk PE treated with USAT were analyzed. Measurements and Main Results: Forty-nine patients underwent bilateral USAT with 0.5 mg/hr/catheter of TPA (unilateral: 1.0 mg/hr). Mean duration of therapy was 22.08 + 4.90 hours. Changes in pulmonary artery pressure (PAP), Clot obstruction index by Miller score and procedure related bleeding complications were assessed. Paired t-testing was used to determine significance Mean RV/LV ratio was 1.52 + 0.36. Miller score decreased 55.0% (mean 19.7 + 3.8 to 8.9 + 4.7; p value < 0.0001). The systolic PAP decreased 7.3% from 63.6 + 15.1 mmHg to 59.0 + 17.5 mmHg (p value = 0.0045). The mean PAP decreased 5.4% from 37.5 + 8.0 mmHg to 35.5 + 9.1 mmHg (p value = 0.0097). No procedural or bleeding related complications occurred. Conclusion: Low dose USAT with 0.5mg/hr/catheter with TPA for 24 hours is highly effective in reducing clot burden and PAP without bleeding or procedural related complications in high Intermediate Risk PE.
AB - Objective: To determine the hemodynamic benefit, clot burden reduction and safety utilizing an ultra-low dose of Tissue Plasminogen Activator (TPA) with Catheter directed Ultrasound accelerated thrombolysis (USAT) in the management of high Intermediate Risk Pulmonary Embolism. Design: Retrospective, observational case series. Setting: Single Center Academic Community Hospital. Patients: Fifty-two consecutive patients (27 males) with high Intermediate Risk PE treated with USAT were analyzed. Measurements and Main Results: Forty-nine patients underwent bilateral USAT with 0.5 mg/hr/catheter of TPA (unilateral: 1.0 mg/hr). Mean duration of therapy was 22.08 + 4.90 hours. Changes in pulmonary artery pressure (PAP), Clot obstruction index by Miller score and procedure related bleeding complications were assessed. Paired t-testing was used to determine significance Mean RV/LV ratio was 1.52 + 0.36. Miller score decreased 55.0% (mean 19.7 + 3.8 to 8.9 + 4.7; p value < 0.0001). The systolic PAP decreased 7.3% from 63.6 + 15.1 mmHg to 59.0 + 17.5 mmHg (p value = 0.0045). The mean PAP decreased 5.4% from 37.5 + 8.0 mmHg to 35.5 + 9.1 mmHg (p value = 0.0097). No procedural or bleeding related complications occurred. Conclusion: Low dose USAT with 0.5mg/hr/catheter with TPA for 24 hours is highly effective in reducing clot burden and PAP without bleeding or procedural related complications in high Intermediate Risk PE.
KW - Pulmonary Embolism; Thrombolysis; Ultrasound Accelerated Thrombolysis
UR - https://digitalcommons.georgiasouthern.edu/bee-facpubs/367
UR - https://biomedres.us/pdfs/BJSTR.MS.ID.006094.pdf
UR - https://www.mendeley.com/catalogue/1c5661e5-de2d-37c0-a535-871620f12444/
U2 - 10.26717/bjstr.2021.38.006094
DO - 10.26717/bjstr.2021.38.006094
M3 - Article
VL - 38
JO - Biomedical Journal of Scientific & Technical Research
JF - Biomedical Journal of Scientific & Technical Research
IS - 1
ER -