Massive pulmonary embolism in patients with extreme bleeding risk: a case series on the successful use of ultrasound-ass
- PDF / 1,477,210 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 20 Downloads / 186 Views
Massive pulmonary embolism in patients with extreme bleeding risk: a case series on the successful use of ultrasound‑assisted, catheter directed thrombolysis in a district general hospital Jingzhou He1,2 · Benjamin Clayton1 · Hibba Kurdi3 · Michael Gibbons4 · Anthony Watkinson5 · Andrew S. P. Sharp6
© The Author(s) 2020
Abstract Massive pulmonary embolism (PE), characterised by profound arterial hypotension, is a life-threatening emergency with a 90-day mortality of over 50%. Systemic thrombolysis can significantly reduce the risk of death or cardiovascular collapse in these patients, by around 50%, but these benefits are offset by a fivefold increased risk of intracranial haemorrhage and major bleeding, which may limit its use in patients at high risk of catastrophic haemorrhage. We describe a case series of 3 patients presenting with massive PE, each with extreme risk of bleeding and contra-indication to systemic thrombolysis, treated successfully with ultrasound-assisted, catheter directed thrombolysis (U-ACDT). Our experience of this novel technique using the EkoSonic Endovascular System (Ekos, BTG, London, UK) on carefully selected patients has demonstrated the potential to improve clinical status in shocked patients, with minimal bleed risk. There have been several clinical studies evaluating the Ekos system. Both the ULTIMA and SEATTLE II studies have shown significant reductions in RV/LV ratio by CT scanning when compared to standard anticoagulation in patients with intermediate-risk PE, with minimal bleeding complications. However, there is a pressing need for a randomised trial demonstrating improvement in robust clinical outcomes when comparing U-ACDT to simple anticoagulation. We believe that this case series adds new insight and highlights the potential of catheter directed thrombolysis in this high-risk patient cohort and consideration should be made to its use in cases where systemic thrombolysis is felt to be too high risk. Keywords Massive Pulmonary Embolism · Thrombolysis · Catheter directed thrombolysis · Interventional cardiology · Bleed risk
Highlights * Jingzhou He [email protected] 1
Department of Cardiology, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
2
Diabetes and Vascular Medicine Research Centre, University of Exeter, Barrack Road, Exeter EX2 5AX, UK
3
Department of Cardiology, Morriston Cardiac Center, Swansea SA6 6NL, UK
4
Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
5
Department of Interventional Radiology, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
6
Department of Cardiology, University Hospital of Wales, Heath Park Way, Cardiff CF14 4XW, UK
• Management of multi-comorbid patients with life-threat-
ening massive PE is complex, and competent multidisciplinary PERT input in decision-making is vital. • These cases have shown the potential of U-ACDT in patients with massive PE and extreme bleed risk with good outcome
Data Loading...
