Ultrasound-assisted catheter-directed thrombolysis versus systemic anticoagulation alone for submassive pulmonary emboli
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Ultrasound‑assisted catheter‑directed thrombolysis versus systemic anticoagulation alone for submassive pulmonary embolism Theresa M. Kline1 · Anne M. Rodino2 · Amy Dorszynski3 · Brian Murray1 · Jonathan Cicci1 · Prashanth Iyer1 Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Pulmonary embolism (PE) is a significant contributor to morbidity and mortality in the United States. Catheter-directed, ultrasound-assisted thrombolysis (USAT) uses high-frequency, low-energy ultrasound waves to disaggregate uncrosslinked fibrin fibers and increase thrombus penetration of a locally delivered thrombolytic to treat an acute PE. The purpose of this study is to compare the efficacy and safety of catheter-directed USAT versus systemic anticoagulation alone in submassive PE. This was a single-center, retrospective study of patients with a diagnosis of acute submassive PE from April 4, 2014 to May 1, 2019 at a large, academic medical center. Subjects were split into two different groups based on treatment with either USAT with systemic anticoagulation or systemic anticoagulation alone. The primary outcome was the incidence of severe or life-threatening GUSTO bleeding within 72 h or until hospital discharge if sooner. A total of 130 subjects were included (n = 40 in the USAT group and n = 90 in systemic anticoagulation alone group). Significantly fewer subjects in the USAT group had an active diagnosis of cancer at the time of presentation (7.5% vs 28.9%, p = 0.006). There was no difference in severe or life-threatening GUSTO bleeding or any component of the GUSTO bleeding definitions. Administration of USAT with systemic anticoagulation was well-tolerated when compared to systemic anticoagulation alone, but bias may have led to selection of patients for USAT with a lower bleeding risk and higher functional status at baseline. Keywords Pulmonary embolism · Catheter-directed · Ultrasound-assisted thrombolysis · Tissue plasminogen activator · Anticoagulation · Catheter-directed thrombolysis
Highlights • A novel approach to catheter directed thrombolysis
(CDT), ultrasound-assisted thrombolysis (USAT), may increase disaggregation of uncrosslinked fibrin fibers and thrombus penetration of a locally delivered thrombolytic for treatment of pulmonary embolism (PE). • We retrospectively compared 90 patients who received USAT with systemic anticoagulation to 40 patients who
* Theresa M. Kline [email protected] 1
University of North Carolina Medical Center, Chapel Hill, NC, USA
2
Northwestern Memorial Hospital, Chicago, IL, USA
3
University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
had received systemic anticoagulation alone for treatment of a submassive PE. • There was no difference observed in the rates of severe or life-threatening GUSTO bleeding or rates of treatment failure between the two groups. • Selection bias have led to fewer subjects with a perceived higher baseline bleeding risk receiving USAT with systemic anticoa
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