Catheter-Based Reperfusion Treatment of Pulmonary Embolism

Engelberger, Rolf P.; Kucher, Nils

doi:10.1161/circulationaha.111.023689

Cited by 121 publications

(84 citation statements)

References 27 publications

(35 reference statements)

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“…Assessing the efficacy of CDT is difficult due to the lack of existing large clinical trials and the low likelihood of future trials comparing catheter therapy to thrombolytic therapy or surgical embolectomy [Engelberger and Kucher, 2011;Jaff et al 2011]. Clinical success rate defined as survival, hemodynamic stability or hypoxia resolution was 86% from pooled study data of 594 PE patients who underwent catheter intervention with or without thrombolysis.…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

“…The catheter must be positioned within the embolus and is initiated with bolus of a fibrinolytic agent followed by continuous infusion. Various dosing regimens for this reperfusion strategy have been reported including urokinase 250,000 IU/h over 2 hours, followed by 100,000 IU/h for 12-24 hours; alteplase 10 mg bolus followed by 20 mg/h over 2 hours or 100 mg over 7 hours [Engelberger and Kucher, 2011].…”

Section: Reperfusion Strategiesmentioning

confidence: 99%

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Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem

Daley

Murthy

Peterson

2015

Therapeutic Advances in Drug Safety

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Acute pulmonary embolism represents a major complication of venous thromboembolism that is associated with high morbidity and mortality. Guidelines recommend the rapid initiation of anticoagulation and consideration of thrombolytic therapy in select patients, including those with hypotension or at high risk of developing hypotension. Evaluation for thrombolytic therapy should only be considered after assessment of contraindications and risk for major bleeding. The objective of this perspective article is to evaluate the bleeding risk associated with systemic thrombolytic therapy in the management of acute pulmonary embolism and discuss strategies to minimize this risk. Risk stratification of acute pulmonary embolism will be discussed to identify patient populations that warrant specific consideration of risk for major bleeding with thrombolytic therapy. In addition, the incidence, patient-specific risk factors, and pharmacologic characteristics, including concurrent anticoagulation and thrombolytic therapy, will be evaluated in the context of risk for major hemorrhage. Finally, supporting evidence for strategies to minimize risk of hemorrhage, including evaluation of contraindications, weight adjusted dosing, infusion strategy and catheter-directed thrombolytic administration will be evaluated. Despite published guidelines and review articles, select aspects to thrombolytic therapy for the management of pulmonary embolism remain controversial and under recognized, including risk of major hemorrhage. When making decisions about the role of thrombolytic therapy in pulmonary embolism, clinicians must be knowledgeable about the associated risks of thrombolytic therapy and individually evaluate patient risk factors prior to determining appropriate candidacy for thrombolytic therapy. For patients considered to be at high risk of major bleeding, strategies to minimize risk should be considered, including weight-adjusted doses and catheter directed therapy. Additional research is needed specific to the acute pulmonary embolism setting to validate risk factors and strategies to minimize major hemorrhage.

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Section: Reperfusion Strategiesmentioning

confidence: 99%

Section: Reperfusion Strategiesmentioning

confidence: 99%

Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem

Daley

Murthy

Peterson

2015

Therapeutic Advances in Drug Safety

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“…In the case of elevated PA pressures, high volume injections for pulmonary angiography are best avoided (42). Suggested injection rates from the experience at our institution include 20 mL/sec over 1 sec in the lobar arteries, which could be lowered to 10 mL/sec for 2 sec in the lobar PAs if pulmonary hypertension is present (17,43). The imaging frame rate should be at least 3 frames/sec, to delineate adequate detail.…”

Section: Measuring Pa Pressurementioning

confidence: 99%

Catheter-directed interventions for pulmonary embolism

Zarghouni

Charles

Maldonado

et al. 2016

Cardiovasc. Diagn. Ther.

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Pulmonary embolism (PE), a potentially life-threatening entity, can be treated medically, surgically, and percutaneously. In patients with right ventricular dysfunction (RVD), anticoagulation alone may be insufficient to restore cardiac function. Because of the morbidity and mortality associated with surgical embolectomy, clinical interest in catheter-directed interventions (CDI) has resurged. We describe specific catheter-directed techniques and the evidence supporting percutaneous treatments.

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“…Несмотря на это, системная ТЛТ приводила к снижению смертности, связанной с ТЭЛА (относительный риск (ОР) 0,17, 95 % доверительный интервал (ДИ) 0,05-0,67) и комбинированной конеч-ной точкой (смерть от любых причин + усиление те-рапии заболевания; ОР 0,37; 95 % ДИ 0,20-0,69). Смертность и вероятность рецидива ТЭЛА в этой группе больных не снижались (ОР 0,42; 95 % ДИ 0,17-1,03 и ОР 0,25; 95 % ДИ 0,06-1,03) [13]. По-скольку вероятность кровотечения при системной ТЛТ у таких лиц повышена, использование локальной те-рапии позволяет уменьшить дозу препарата и снизить риск этого грозного осложнения [14,15].…”

Section: описание случаяunclassified