REGULAR CONTENT
Final ID
579
Type
Original Scientific Research-Oral or Pos
Authors
D Patel1, R Lokken1, J Bui1, A Lipnik1, C Ray1, R Gaba1
Institutions
1University of Illinois Hospital and Health Sciences System, Chicago, IL
Purpose
Catheter directed thrombolysis (CDT) improves pulmonary arterial pressure (PAP) compared to anticoagulation alone in submassive pulmonary embolism (PE), but the optimal duration of CDT is uncertain. The European ULTIMA and SEATTLE II studies performed ultrasound-assisted CDT for 12-24 h with 10-24 mg t-PA. The purpose of this study is to assess the incremental change in PAP in patients with submassive PE undergoing multi-day CDT.
Materials & Methods
Records of 40 consecutive patients (22 men, 18 women, mean age 55 y) who underwent CDT between 2009 and 2016 for submassive PE as defined by American Heart Association guidelines were retrospectively reviewed. Mean RV/LV diameter was 1.7±0.8; 25 (63%) had both RV enlargement and biomarker elevation. CDT was performed with a 7Fr Van Aman catheter with t-PA at 0.7±0.2 mg/hr. Concurrent IV unfractionated heparin was given with goal PTT of 60-80s. PAP was measured at baseline and every 24 h until CDT was terminated at operator discretion. PAP measurements were compared with the paired samples t-test.
Results
Patients underwent CDT for a mean 68±33 h with 46±31 mg t-PA. Median hospital stay was 8 d (range, 1-31 d); median clinical follow-up was 297 d (range, 1-2520 d). Mean systolic PAP significantly decreased from 53.5±15.3 mmHg at baseline to 45.0±12.3 mmHg at 19±5 h (P<0.001), 43.0±14.6 mmHg at 43±6 h (P<0.001) and 35.4±14.0 mmHg at CDT termination (85±27 h) (P<0.001). Significant incremental decreases in mean systolic PAP were observed beyond single-day CDT both at 43 h (P=0.004) and CDT termination (P<0.001) compared with 19 h. One GUSTO-defined severe bleed (fatal intracranial hemorrhage 22 h after CDT initiation in the setting of PTT>200s) occurred. No GUSTO-defined moderate bleeding events occurred. One patient died of cardiac arrest 16 h after CDT initiation; no additional deaths were observed within 30 days.
Conclusions
Continuation of CDT beyond one day may result in greater PAP reduction in patients with submassive PE without increased incidence of severe bleeding events. An extended duration of thrombolysis should be considered for clinical trials assessing long-term outcomes of CDT for submassive PE.
Final ID
579
Type
Original Scientific Research-Oral or Pos
Authors
D Patel1, R Lokken1, J Bui1, A Lipnik1, C Ray1, R Gaba1
Institutions
1University of Illinois Hospital and Health Sciences System, Chicago, IL
Purpose
Catheter directed thrombolysis (CDT) improves pulmonary arterial pressure (PAP) compared to anticoagulation alone in submassive pulmonary embolism (PE), but the optimal duration of CDT is uncertain. The European ULTIMA and SEATTLE II studies performed ultrasound-assisted CDT for 12-24 h with 10-24 mg t-PA. The purpose of this study is to assess the incremental change in PAP in patients with submassive PE undergoing multi-day CDT.
Materials & Methods
Records of 40 consecutive patients (22 men, 18 women, mean age 55 y) who underwent CDT between 2009 and 2016 for submassive PE as defined by American Heart Association guidelines were retrospectively reviewed. Mean RV/LV diameter was 1.7±0.8; 25 (63%) had both RV enlargement and biomarker elevation. CDT was performed with a 7Fr Van Aman catheter with t-PA at 0.7±0.2 mg/hr. Concurrent IV unfractionated heparin was given with goal PTT of 60-80s. PAP was measured at baseline and every 24 h until CDT was terminated at operator discretion. PAP measurements were compared with the paired samples t-test.
Results
Patients underwent CDT for a mean 68±33 h with 46±31 mg t-PA. Median hospital stay was 8 d (range, 1-31 d); median clinical follow-up was 297 d (range, 1-2520 d). Mean systolic PAP significantly decreased from 53.5±15.3 mmHg at baseline to 45.0±12.3 mmHg at 19±5 h (P<0.001), 43.0±14.6 mmHg at 43±6 h (P<0.001) and 35.4±14.0 mmHg at CDT termination (85±27 h) (P<0.001). Significant incremental decreases in mean systolic PAP were observed beyond single-day CDT both at 43 h (P=0.004) and CDT termination (P<0.001) compared with 19 h. One GUSTO-defined severe bleed (fatal intracranial hemorrhage 22 h after CDT initiation in the setting of PTT>200s) occurred. No GUSTO-defined moderate bleeding events occurred. One patient died of cardiac arrest 16 h after CDT initiation; no additional deaths were observed within 30 days.
Conclusions
Continuation of CDT beyond one day may result in greater PAP reduction in patients with submassive PE without increased incidence of severe bleeding events. An extended duration of thrombolysis should be considered for clinical trials assessing long-term outcomes of CDT for submassive PE.