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Gill KPS, O'Brien DP, Soverow JE. Use of Ultrasound-Assisted, Catheter-Directed Thrombolysis in a Patient With High-Risk Pulmonary Embolism. Tex Heart Inst J 2024; 51:e238235. [PMID: 38317350 DOI: 10.14503/thij-23-8235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
High-risk pulmonary embolism (PE) is a complex clinical entity associated with high mortality rates. Ultrasound-assisted, catheter-directed thrombolysis, typically used for intermediate-risk PE, may be a viable treatment approach for high-risk PE, particularly in patients at increased risk for major bleeding. This report describes a case in which ultrasound-assisted, catheter-directed thrombolysis was successfully used to treat high-risk PE in a female patient with extensive peritoneal metastases from gastric adenocarcinoma. Other examples from the literature, in which ultrasound-assisted, catheter-directed thrombolysis was used to treat high-risk PE, are also provided.
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Affiliation(s)
- Karam P S Gill
- Department of Internal Medicine, Olive View-University of California Los Angeles Medical Center, Sylmar, California
| | - Daniel P O'Brien
- Department of Cardiology, Olive View-University of California Los Angeles Medical Center, Sylmar, California
| | - Jonathan E Soverow
- Department of Cardiology, Olive View-University of California Los Angeles Medical Center, Sylmar, California
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Inzunza-Cervantes G, Velarde-Pérez D, Saldaña-García JH, Espinoza-Escobar G, Velázquez-Mejía FDJ. [Ultrasound-accelerated thrombolysis. Initial experience in patients with contraindications to systemic thrombolysis]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:370-379. [PMID: 37216692 PMCID: PMC10437234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 05/24/2023]
Abstract
Background acute pulmonary embolism (APE) is a complex and potentially deadly entity, with a variable clinical course, considered the third cardiovascular cause of death. Its management varies according to the stratified risk from anticoagulation to reperfusion therapy, suggesting systemic thrombolysis as a first-choice strategy; however, in a large group of patients their use will be contraindicated, discouraged or will have failed, thus recommending as options in such cases endovascular therapies or surgical embolectomy. With the presentation of 3 clinical cases and a review of the literature, we seek to communicate our initial experience in the use of ultrasound-accelerated thrombolysis with the EKOS system and to investigate key elements for its understanding and application. Clinical cases the cases of 3 patients with APE of high and intermediate risk with contraindications for systemic thrombolysis taken to accelerated thrombolysis therapy by ultrasound are discussed. They presented adequate clinical and hemodynamic evolution in the short term, achieving a rapid decrease in thrombolysis, systolic and mean pulmonary arterial pressure, improvement of right ventricular function and reduction of thrombotic burden. Conclusion Ultrasound-accelerated thrombolysis is a novel pharmaco-mechanical therapy that combines the emission of ultrasonic waves with the infusion of a local thrombolytic agent, a strategy that, according to different trials and clinical registries, has a high success rate and a good safety profile.
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Affiliation(s)
- Gustavo Inzunza-Cervantes
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Daniel Velarde-Pérez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - José Hernando Saldaña-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología Intervencionista. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gabriela Espinoza-Escobar
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Felipe de Jesús Velázquez-Mejía
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste, Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología. Ciudad Obregón, Sonora, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Mazahreh F, Habash F, López-Candales A. Venous Thromboembolism While on Anticoagulation With Apixaban. Cureus 2021; 13:e15189. [PMID: 34178510 PMCID: PMC8218250 DOI: 10.7759/cureus.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 12/04/2022] Open
Abstract
Venous thromboembolism (VTE) is a common condition whose pathophysiology is explained by Virchow's triad with stasis, hypercoagulability, and endothelial injury. Direct oral anticoagulants (DOACs) showed non-inferiority when compared with conventional treatment using subcutaneous low molecular weight heparin (LMWH) and warfarin, but treatment failure is a concern and remains a challenge for physicians. In our case report, we present a patient who had VTE in the form of a saddle pulmonary embolus while on apixaban.
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Affiliation(s)
- Farah Mazahreh
- Cardiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Fuad Habash
- Cardiology, University of Arkansas for Medical Sciences, Little Rock, USA
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Guliani S, Das Gupta J, Osofsky R, Marek J, Rana MA, Marinaro J. Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients. Perfusion 2020; 35:641-648. [PMID: 31948384 DOI: 10.1177/0267659119896891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of protocolized use of catheter-directed thrombolysis and echocardiography in submassive pulmonary embolism patients. METHODS A retrospective study at a single institution of 28 patients that presented with submassive pulmonary embolism from July 2016 to September 2019 was performed. All patients were diagnosed using chest computed tomography demonstrating a pulmonary embolism and abnormal right ventricular to left ventricular ratio. Patients with severe right heart dysfunction (right ventricular to left ventricular ratio ⩾1.4) were protocolized to receive catheter-directed thrombolysis via EkoSonic catheters (EKOS Corporation, Bothell, WA, United States). Transthoracic echocardiogram was performed after 24 hours to assess right ventricular function and determine the need to continue thrombolysis. Patients after discharge then received follow-up echocardiograms at 6 weeks to determine new post-treatment baseline. RESULTS The mean patient age was 54.6 years, mean body mass index was 35.0, and mean right ventricular to left ventricular ratio on admission computed tomography imaging was 1.70. Interval mean right ventricular to left ventricular ratio on echocardiography during thrombolysis therapy was 1.01 (p < 0.00001). Patients were tachycardic on admission (mean heart rate 102.2 beats per minute) with improvement by completion of thrombolysis (mean heart rate 72.9 beats per minute) (p < 0.00001). There was a 0% incidence of periprocedural complications. Overall 30-day complication rate was 7.1% (n = 1 arrhythmia, n = 1 delayed intracranial hemorrhage). At 6-week follow-up, 91% of the patients who received echocardiography had normal right ventricular function. CONCLUSION This retrospective study demonstrates the effectiveness of protocolized use of catheter-directed thrombolysis and echocardiography in reversing severe right heart dysfunction in submassive pulmonary embolism patients.
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Affiliation(s)
- Sundeep Guliani
- Department of Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Division of Vascular Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Critical Care, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jaideep Das Gupta
- Department of Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Robin Osofsky
- Department of Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - John Marek
- Department of Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Division of Vascular Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Muhammad Ali Rana
- Department of Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Division of Vascular Surgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jon Marinaro
- Department of Critical Care, School of Medicine, University of New Mexico, Albuquerque, NM, USA
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