Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II sub-analysis

Abstract

Elderly patients with acute pulmonary embolism (PE) have higher mortality than non-elderly patients, but receive systemic fibrinolysis less frequently. In this sub-analysis of the SEATTLE II trial, we evaluated the efficacy and safety of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with submassive and massive PE. We compared patients ⩾65 years old with those <65 years old. Eligible patients had proximal PE and a right ventricular-to-left ventricular (RV/LV) diameter ratio ⩾0.9 on chest computed tomography (CT). The primary efficacy outcome was the change in chest CT-measured RV/LV diameter ratio at 48 hours after procedure initiation. The primary safety outcome was major bleeding within 72 hours. Sixty-two patients were ⩾65 years of age and 88 were <65 years of age. The RV/LV diameter ratio decreased in both groups 48 hours post-procedure, with a mean change of -0.47 in those ⩾65 and -0.39 in those <65 years old, with no difference between groups ( p = 0.31). Major bleeding occurred in nine (15%) of those ⩾65 and in six (7%) of those <65 years old ( p = 0.17). Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis resulted in a similar reduction in RV/LV diameter ratio in elderly patients with massive and submassive PE compared with non-elderly patients.

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

“…Also, Bagla et al [ 16 ] highlighted that the mean RV/LV ratio declined from 1.59 to 0.93 (P < 0.001), indicating a considerable improvement in RVD. Moreover, similar improvements in the RV/LV ratio and modified Miller index were reported at 48 hours in various studies [ 15 , 17 , 20 ].…”

Analysis of pulmonary embolism patients treated with EkoSonicTM endovascular system

“…[15] In the SEATTLE II sub-analysis study, it was emphasized that elderly patients had higher PE-related mortality and less systemic thrombolytic therapy, compared to younger patients. [16] When patients over 65 years and below 65 years were compared, there was no significant difference between the decrease in the RV/LV ratios after the procedure and in major bleeding rates after 72 h. [16] Although this study did not compare USAT with the systemic thrombolytic group, the results that support the safety and efficacy of USAT were observed.…”

Outcome Measures for Acute Submassive Pulmonary Embolisms at a Community-Based Hospital Using Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis

“…With over 275 000 hospitalizations a year, pulmonary embolisms (PEs) are the third major cause of cardiovascular morbidity and mortality, behind myocardial infarction and stroke. [1][2][3][4][5][6] PE management is based on classification into three categories: low risk (nonmassive), intermediate (submassive), and high risk (massive). Consensus exists regarding the management of low-and high-risk PEs in the medical community, heparin and systemic fibrinolysis, respectively.…”