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Local Ultrasound-Facilitated Thrombolysis in High-Risk Pulmonary Embolism: First Dutch Experience

Authors
  • de Winter, Maria A.1
  • Hart, Einar A.2
  • van den Heuvel, Daniel A. F.3
  • Moelker, Adriaan4
  • Lely, Rutger J.5
  • Kaasjager, Karin A. H.1
  • Stella, Pieter R.2
  • Chamuleau, Steven A. J.2
  • Kraaijeveld, Adriaan O.2
  • Nijkeuter, Mathilde1
  • 1 University Medical Center Utrecht, Department of Internal Medicine, Heidelberglaan 100, Utrecht, The Netherlands , Utrecht (Netherlands)
  • 2 University Medical Center Utrecht, Department of Cardiology, Heidelberglaan 100, Utrecht, The Netherlands , Utrecht (Netherlands)
  • 3 St. Antonius Hospital, Department of Interventional Radiology, Koekoekslaan 1, Nieuwegein, The Netherlands , Nieuwegein (Netherlands)
  • 4 Erasmus Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Doctor Molewaterplein 40, Rotterdam, The Netherlands , Rotterdam (Netherlands)
  • 5 VU University Medical Center, Department of Interventional Radiology, De Boelelaan 1117, Amsterdam, The Netherlands , Amsterdam (Netherlands)
Type
Published Article
Journal
CardioVascular and Interventional Radiology
Publisher
Springer-Verlag
Publication Date
Mar 12, 2019
Volume
42
Issue
7
Pages
962–969
Identifiers
DOI: 10.1007/s00270-019-02200-1
Source
Springer Nature
Keywords
License
Green

Abstract

PurposeTo provide insight into the current use and results of ultrasound-facilitated catheter-directed thrombolysis (USAT) in patients with high-risk pulmonary embolism (PE).IntroductionSystemic thrombolysis is an effective treatment for hemodynamically unstable, high-risk PE, but is associated with bleeding complications. USAT is thought to reduce bleeding and is therefore advocated in patients with high-risk PE and contraindications for systemic thrombolysis.MethodsWe conducted a retrospective cohort study of all patients who underwent USAT for high-risk PE in the Netherlands from 2010 to 2017. Characteristics and outcomes were analyzed. Primary outcomes were major (including intracranial and fatal) bleeding and all-cause mortality after 1 month. Secondary outcomes were all-cause mortality and recurrent venous thromboembolism within 3 months.Results33 patients underwent USAT for high-risk PE. Major bleeding occurred in 12 patients (36%, 95% CI 22–53), including 1 intracranial and 3 fatal bleeding. All-cause mortality after 1 month was 48% (16/33, 95% CI 31–66). All-cause mortality after 3 months was 50% (16/32, 95% CI 34–66), recurrent venous thromboembolism occurred in 1 patient (1/32, 3%, 95% CI 1–16).ConclusionsThis study was the first to describe characteristics and outcomes after USAT in a study population of patients with high-risk PE only, an understudied population. Although USAT is considered a relatively safe treatment option, our results illustrate that at least caution is needed in critically ill patients with high-risk PE. Further research in patients with high-risk PE is warranted to guide patient selection.

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