Among patients with acute pulmonary embolism, ultrasound-assisted catheter-directed thrombolysis was associated with reduced complications, but patients at high risk remained vulnerable to short-term mortality, researchers reported.
The researchers conducted a retrospective analysis of 141 patients with acute PE who underwent ultrasound-assisted catheter-directed thrombolysis. Patients were stratified by whether their PE was high risk or intermediate high risk. Median follow-up was 752 days.
Mean tissue-type plasminogen activator dose was 36.1 mg. Mean infusion duration was 24.5 hours.
According to the researchers, regardless of risk category, ultrasound-assisted catheter-directed thrombolysis was associated with improvements in the following: echocardiographic measures of right ventricular systolic function, pulmonary-arterial obstruction score, RV-to-left ventricle diameter ratio, right to left atrial diameter ratio and pulmonary artery pressures (P < .0001 for all).
Among the cohort, in-hospital mortality was 5.7%, the major bleeding rate was 7.8% and the minor bleeding rate was 11.3%, Cihangir Kaymaz, MD, from the department of cardiology at University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, and colleagues wrote.
Compared with patients aged at least 65 years, those younger than 65 years had higher absolute and percentage changes in RV/LV ratio and percentage change in pulmonary artery pressures, according to the researchers.
Age, tissue-type plasminogen activator dosage and infusion duration were not related to bleeding, 30-day mortality or long-term mortality, Kaymaz and colleagues wrote.
However, 30-day mortality was significantly higher in the high-risk group vs. the intermediate high-risk group (17.6% vs. 4%), and a similar but nonsignificant trend was seen in long-term mortality (29.4% vs. 11.3%; HR = 2.56; 95% CI, 0.92-7.69).
Ultrasound-assisted catheter-directed thrombolysis “should be considered as an efficacious and safe treatment strategy in patients with acute PE at [high risk] and [intermediate high risk] who are prone to an increased bleeding risk with systemic [thrombolytic therapy] or a candidate for progression to more severe obstruction with anticoagulants,” Kaymaz and colleagues wrote. “However, even with [ultrasound-assisted catheter-directed thrombolysis, high-risk status] increases the 30-day mortality.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.