Outcomes of Catheter-Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism

Hennemeyer, Charles; Khan, Abdul Aleem; McGregor, Hugh; Moffett, Cheyenne; Woodhead, Gregory

doi:10.1016/j.amjmed.2018.10.015

Cited by 24 publications

(22 citation statements)

References 18 publications

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“…Although not examined in this study, other known benefits of PERT that could have led to improved outcomes include reduced time to anticoagulation, individualized anticoagulant choice, improved outpatient follow‐up, and increased medication compliance 11 . In addition, Hennemeyer et al showed lower readmission in PE patients who underwent catheter‐direct therapy compared to those who received anticoagulation alone 15 …”

Section: Discussionmentioning

confidence: 80%

Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism

Parikh

Chahine

Hammad

et al. 2021

Cathet Cardio Intervent

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Objectives We sought to examine predictors of pulmonary embolism response team (PERT) utilization and identify those who could benefit from advanced therapy. Background PERT and advanced therapy use remain low. Current risk stratification tools heavily weight age and comorbidities, which may not always correlate with presentation's severity. Methods We prospectively studied patients with CT‐confirmed PE between January 2019 and December 2019 at our hospital. PERT activation was left to the treating physician. Multivariable analyses were utilized to identify predictors of PERT activation and advanced therapy. Using the log odd ratio of each significant predictor of advanced therapy, we created a scoring system and a score of 2 was associated with the highest use. Primary outcomes were 30‐ and 90‐day all‐cause mortality, readmission, and major bleed. Results Of the 307 patients, PERT was activated in 22.5%. While abnormal vital signs and right ventricular (RV) strain were associated with PERT activation, pulmonary embolism severity index (PESI) was not. Advanced therapy use was significantly higher in the PERT cohort (35% vs 2%). Predictors of advanced therapy use were composite variable (heart rate > 110 or systolic blood pressure < 100 or respiratory rate > 30 or oxygen saturation < 90%) and right‐to‐left ventricular ratio > 0.9. PERT patients with advanced therapy use, when compared to the no‐PERT patients who could have qualified (score of 2), had significantly lower 30‐ and 90‐day mortality and 30‐day readmission without difference in major bleed. Conclusion PERT has important therapeutic impact, yet no guidelines to direct activation. We recommend a multidisciplinary approach for higher acuity pulmonary embolism cases and physician education regarding PERT and the scope of advanced therapy use.

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Section: Discussionmentioning

confidence: 80%

Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism

Parikh

Chahine

Hammad

et al. 2021

Cathet Cardio Intervent

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“…After thrombectomy, the patient's clinical improvement correlated with the recovery of cardiac function. One study reports an advantage of catheter-directed thrombectomy over treatment with anticoagulation only in patients with submassive PE, as reflected by an improvement in the right/left ventricular ratio [15] . Except for mild to moderate cardiac arrhythmias, the patient tolerated the procedure well.…”

Section: Discussionmentioning

confidence: 99%

Successful aspiration thrombectomy in a patient with submassive, intermediate-risk pulmonary embolism following COVID-19 pneumonia

Pohlan

Kamel

Torsello

et al. 2020

Radiology Case Reports

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A 64-year-old female patient presented with severe dyspnea shortly after apparent recovery from COVID-19 disease. Chest computed tomography revealed central pulmonary embolism and ultrasonography showed a deep vein thrombosis of her right leg. The patient was tachycardiac with evidence of right ventricular strain on echocardiography. An interdisciplinary decision for interventional therapy was made. Angiographic aspiration thrombectomy resulted in a significant reduction of thrombus material and improved flow in the pulmonary arteries and immediate marked clinical improvement and subsequent normalization of functional echocardiographic parameters. This case adds to the emerging evidence for severe thromboembolic complications following COVID-19 and suggests aspiration thrombectomy can be considered in pulmonary embolism of intermediate risk.

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“…27 Two previous trials assessing the efficacy of CDT versus systemic thrombolysis demonstrated improved cardiovascular haemodynamics following CDT administration of tissue plasminogen activator, with no increased risk of intracranial haemorrhaging in CDT. 28,29 Moreover some investigators support catheter-directed treatment as a potential first-line therapeutic approach for Covid-19. 30 However, large studies are warranted to determine the optimal dosing regimen of systemic thrombolysis and CDT with or without therapeutic anticoagulation in COVID-19 ARDS .…”

Section: Catheter-directed Thrombolysismentioning

confidence: 99%

Catheter-Based Local Delivery of Therapeutics to the Lungs for Severe or Critically Ill Patients with COVID-19

et al. 2021

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Outcomes of Catheter-Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism

Cited by 24 publications

References 18 publications

Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism

Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism

Successful aspiration thrombectomy in a patient with submassive, intermediate-risk pulmonary embolism following COVID-19 pneumonia

Catheter-Based Local Delivery of Therapeutics to the Lungs for Severe or Critically Ill Patients with COVID-19

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