Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism:
Current guidelines recommend anticoagulation alone for low-risk pulmonary embolism (PE) with the addition of systemic thrombolysis for high-risk PE. However, treatment recommendations for intermediate-risk PE are not well-defined. Due to bleeding risks associated with systemic thrombolysis, ultrasou...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-02-01
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| Series: | Journal of Cardiovascular Pharmacology and Therapeutics |
| Online Access: | https://doi.org/10.1177/10742484241238656 |
| _version_ | 1797260699781562368 |
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| author | Jasmine Ventenilla PharmD Todd Rushing PharmD Becky Ngu PharmD David Shavelle MD Neepa Rai PharmD |
| author_facet | Jasmine Ventenilla PharmD Todd Rushing PharmD Becky Ngu PharmD David Shavelle MD Neepa Rai PharmD |
| author_sort | Jasmine Ventenilla PharmD |
| collection | DOAJ |
| description | Current guidelines recommend anticoagulation alone for low-risk pulmonary embolism (PE) with the addition of systemic thrombolysis for high-risk PE. However, treatment recommendations for intermediate-risk PE are not well-defined. Due to bleeding risks associated with systemic thrombolysis, ultrasound-assisted catheter-directed thrombolysis (USAT) has evolved as a promising treatment modality. USAT is thought to decrease the rate of major bleeding by using localized delivery with lower thrombolytic dosages. Currently, there is little guidance on the implementation of USAT in the real-world clinical setting. This study was designed to evaluate our experience with USAT at this single community hospital with a newly initiated Pulmonary Embolism Response Team (PERT). All patients identified by the PERT with an acute PE diagnosed by a computed tomography (CT) scan from January 2021 to January 2023 were included. During the study period, there were 89 PERT activations with 40 patients (1 high-risk and 37 intermediate-risk PE) receiving USAT with alteplase administered at a fixed rate of 1 mg/h per catheter for 6 h. The primary efficacy outcome was the change in Pulmonary Embolism Severity Index (PESI) score within 48 h after USAT. The primary safety outcome was major bleeding within 72 h. The mean age was 57.4 ± 17.4 years and 50% (n = 20) were male, 17.5% (n = 7) had active malignancy, and 20% (n = 8) had a history of prior deep vein thrombosis (DVT) or PE. The mean PESI score decreased from baseline to 48 h post-USAT (84.7 vs 74.9; p = 0.025) and there were no major bleeding events. The overall hospital length of stay was 7.5 ± 9.8 days and ICU length of stay was 2.2 ± 2.8 days. This study outlined our experience at this single community hospital which resulted in an improvement in PESI scores and no major bleeding events observed. |
| first_indexed | 2024-04-24T23:29:29Z |
| format | Article |
| id | doaj.art-a520bc7e0f494fdcab0e8f3da6dfe072 |
| institution | Directory Open Access Journal |
| issn | 1940-4034 |
| language | English |
| last_indexed | 2024-04-24T23:29:29Z |
| publishDate | 2024-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Cardiovascular Pharmacology and Therapeutics |
| spelling | doaj.art-a520bc7e0f494fdcab0e8f3da6dfe0722024-03-15T17:04:06ZengSAGE PublishingJournal of Cardiovascular Pharmacology and Therapeutics1940-40342024-02-012910.1177/10742484241238656Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: Jasmine Ventenilla PharmD0Todd Rushing PharmD1Becky Ngu PharmD2David Shavelle MD3Neepa Rai PharmD4 Department of Pharmacy, , Long Beach, CA, USA Department of Pharmacy, , Long Beach, CA, USA Department of Pharmacy, , Long Beach, CA, USA Department of Cardiology, , Long Beach Medical Center, Long Beach, CA, USA Department of Pharmacy, , Long Beach, CA, USACurrent guidelines recommend anticoagulation alone for low-risk pulmonary embolism (PE) with the addition of systemic thrombolysis for high-risk PE. However, treatment recommendations for intermediate-risk PE are not well-defined. Due to bleeding risks associated with systemic thrombolysis, ultrasound-assisted catheter-directed thrombolysis (USAT) has evolved as a promising treatment modality. USAT is thought to decrease the rate of major bleeding by using localized delivery with lower thrombolytic dosages. Currently, there is little guidance on the implementation of USAT in the real-world clinical setting. This study was designed to evaluate our experience with USAT at this single community hospital with a newly initiated Pulmonary Embolism Response Team (PERT). All patients identified by the PERT with an acute PE diagnosed by a computed tomography (CT) scan from January 2021 to January 2023 were included. During the study period, there were 89 PERT activations with 40 patients (1 high-risk and 37 intermediate-risk PE) receiving USAT with alteplase administered at a fixed rate of 1 mg/h per catheter for 6 h. The primary efficacy outcome was the change in Pulmonary Embolism Severity Index (PESI) score within 48 h after USAT. The primary safety outcome was major bleeding within 72 h. The mean age was 57.4 ± 17.4 years and 50% (n = 20) were male, 17.5% (n = 7) had active malignancy, and 20% (n = 8) had a history of prior deep vein thrombosis (DVT) or PE. The mean PESI score decreased from baseline to 48 h post-USAT (84.7 vs 74.9; p = 0.025) and there were no major bleeding events. The overall hospital length of stay was 7.5 ± 9.8 days and ICU length of stay was 2.2 ± 2.8 days. This study outlined our experience at this single community hospital which resulted in an improvement in PESI scores and no major bleeding events observed.https://doi.org/10.1177/10742484241238656 |
| spellingShingle | Jasmine Ventenilla PharmD Todd Rushing PharmD Becky Ngu PharmD David Shavelle MD Neepa Rai PharmD Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: Journal of Cardiovascular Pharmacology and Therapeutics |
| title | Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: |
| title_full | Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: |
| title_fullStr | Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: |
| title_full_unstemmed | Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: |
| title_short | Ultrasound-Assisted Catheter-Directed Thrombolysis for the Management of Pulmonary Embolism: |
| title_sort | ultrasound assisted catheter directed thrombolysis for the management of pulmonary embolism |
| url | https://doi.org/10.1177/10742484241238656 |
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