An Eight-year, Single-center Experience on Ultrasound Assisted Thrombolysis with Moderate-dose, Slow-infusion Regimen in Pulmonary Embolism

Title:An Eight-year, Single-center Experience on Ultrasound Assisted Thrombolysis with Moderate-dose, Slow-infusion Regimen in Pulmonary Embolism

Volume: 20 Issue: 4

Author(s): Cihangir Kaymaz*, Ozgur Yasar Akbal, Berhan Keskin, Hacer Ceren Tokgoz, Aykun Hakgor, Ali Karagoz, Seda Tanyeri, Barkın Kultursay, Seyhmus Kulahcioglu, Cem Dogan, Zubeyde Bayram, Süleyman Çağan Efe, Atakan Erkılınç, Ibrahim Halil Tanboga, Mehmet Akbulut, Nihal Ozdemir, Victor Tapson and Stavros Konstantinides

Affiliation:

• Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey

Keywords: Ultrasound assisted thrombolysis, catheter directed thrombolysis, pulmonary embolism, bleeding, mortality, tissue plasminogen activator.

Abstract:

Background: There is limited data on moderate-dose with slow-infusion thrombolytic regimen by ultrasound-asssisted-thrombolysis (USAT) in patients with acute pulmonary embolism (PE).

Aims: In this study, our eight-year experience on USAT with moderate-dose, slow-infusion tissue-type plasminogen activator (t-PA) regimen in patients with PE at intermediate-high- and high-risk was presented, and short-, and long-term effectiveness and safety outcomes were evaluated.

Methods: Our study is based on the retrospective evaluation of 225 patients with PE having multiple comorbidities who underwent USAT.

Results: High- and intermediate-high-risk were noted in 14.7% and in 85.3% of patients, respectively. Mean t-PA dosage was 35.4±13.3 mg, and the infusion duration was 26.6±7.7 h. Measures of pulmonary artery (PA) obstruction and right ventricle (RV) dysfunction were improved within days (p<0.0001 for all). During the hospital stay, major and minor bleeding and mortality rates were 6.2%, 12.4%, and 6.2%, respectively. Bleeding and unresolved PE accounted for 50% and 42.8% of in-hospital mortality, respectively. Age, rate, and duration of t-PA were not associated with in-hospital major bleeding and mortality. Oxygen saturation exceeded 90% in 91.2% of patients at discharge. During follow-up of median 962 (610-1894) days, high-risk status related to 30-day mortality, whereas age >65 years was associated with long-term mortality.

Conclusion: Our real-life experience with USAT with moderate-dose, slow-infusion t-PA regimen in patients with PE at high-and intermediate-high risk demonstrated clinically relevant improvements in PA obstructive burden and RV dysfunction. Age, rate or infusion duration of t-PA was not related to major bleeding or mortality risk, whereas unresolved obstruction remained as a lethal issue.

Cite this article as:

Kaymaz Cihangir*, Akbal Yasar Ozgur, Keskin Berhan, Tokgoz Ceren Hacer, Hakgor Aykun, Karagoz Ali, Tanyeri Seda, Kultursay Barkın, Kulahcioglu Seyhmus, Dogan Cem, Bayram Zubeyde, Efe Çağan Süleyman, Erkılınç Atakan, Tanboga Halil Ibrahim, Akbulut Mehmet, Ozdemir Nihal, Tapson Victor and Konstantinides Stavros, An Eight-year, Single-center Experience on Ultrasound Assisted Thrombolysis with Moderate-dose, Slow-infusion Regimen in Pulmonary Embolism, Current Vascular Pharmacology 2022; 20 (4) . https://dx.doi.org/10.2174/1570161120666220428095705