Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism.

Détails

ID Serval
serval:BIB_4EE2738405A0
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism.
Périodique
European Heart Journal
Auteur⸱e⸱s
Engelberger R.P., Moschovitis A., Fahrni J., Willenberg T., Baumann F., Diehm N., Do D.D., Baumgartner I., Kucher N.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
36
Numéro
10
Pages
597-604
Langue
anglais
Résumé
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.
Mots-clé
Aged, Catheterization/methods, Drug Delivery Systems, Female, Humans, Infusions, Intravenous, Male, Pulmonary Embolism/drug therapy, Retrospective Studies, Risk Factors, Thrombolytic Therapy/methods, Tissue Plasminogen Activator/administration & dosage, Ultrasonography, Interventional/methods
Pubmed
Web of science
Création de la notice
12/02/2016 13:35
Dernière modification de la notice
20/08/2019 14:04
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