High Intermediate Risk Pulmonary Embolism: The Use of Very Low Dose Catheter-Directed Ultrasound- Accelerated Thrombolysis
Biomedical Journal of Scientific & Technical Research
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.
Greenspon, Lee W., Ryan D. Reber, Ravi Desai, Theodore J. Plush, Matthew Hegewald, Haresh Rochani, Peter A. Villas, Joseph Bonn.
"High Intermediate Risk Pulmonary Embolism: The Use of Very Low Dose Catheter-Directed Ultrasound- Accelerated Thrombolysis."
Biomedical Journal of Scientific & Technical Research, 38 (1): 29999-30005: Biomedical Research Network.