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Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery.

Dilektasli AG, Demirdogen Cetinoglu E, Acet NA, Erdogan C, Ursavas A, Ozkaya G, Coskun F, Karadag M, Ege E - Med. Sci. Monit. (2016)

Bottom Line: The primary outcomes were mortality, clinical success, and complications.Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure.In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.

ABSTRACT
BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. MATERIAL AND METHODS Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. RESULTS The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2 ± 16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04-0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2-98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. CONCLUSIONS CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

No MeSH data available.


Related in: MedlinePlus

Comparison of change in hemodynamic parameters in massive (n=6) vs. submassive (n=9) pulmonary embolism (PE) groups. Dark grey bars represent change from baseline to second hour, grey bars represent change from baseline to the eighth hour, dark grey bars represent change from baseline to 24th hour, and the error bars 95% CIs for the medians. Statistical significance was determined by the the Mann-Whitney U test for comparison of continuous nonnormal data between massive PE vs. submassive PE groups. SpO2=oxygen saturation measured at room air.
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f2-medscimonit-22-1265: Comparison of change in hemodynamic parameters in massive (n=6) vs. submassive (n=9) pulmonary embolism (PE) groups. Dark grey bars represent change from baseline to second hour, grey bars represent change from baseline to the eighth hour, dark grey bars represent change from baseline to 24th hour, and the error bars 95% CIs for the medians. Statistical significance was determined by the the Mann-Whitney U test for comparison of continuous nonnormal data between massive PE vs. submassive PE groups. SpO2=oxygen saturation measured at room air.

Mentions: SBP, DBP, HR, shock index (SI), and SaO2 significantly improved within 24 hours after the CDT procedure (Figure 2). Notably, recovery started in the first 2 hours and was significantly evident in all hemodynamic parameters in the first 8 hours after intervention and hemodynamic improvement continued to occur over a 24-hour period. PAP improved from 59.9±12.5 mm Hg to 38.9±8.5 mm Hg (P<0.0001). Stabilization of hemodynamic parameters was achieved in the first 24 hours in 93.3% (95% CI, 70.2–98.8) of patients. The 1 unstabilized patient had massive PE; this patient died of advanced cancer during hospitalization.


Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery.

Dilektasli AG, Demirdogen Cetinoglu E, Acet NA, Erdogan C, Ursavas A, Ozkaya G, Coskun F, Karadag M, Ege E - Med. Sci. Monit. (2016)

Comparison of change in hemodynamic parameters in massive (n=6) vs. submassive (n=9) pulmonary embolism (PE) groups. Dark grey bars represent change from baseline to second hour, grey bars represent change from baseline to the eighth hour, dark grey bars represent change from baseline to 24th hour, and the error bars 95% CIs for the medians. Statistical significance was determined by the the Mann-Whitney U test for comparison of continuous nonnormal data between massive PE vs. submassive PE groups. SpO2=oxygen saturation measured at room air.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4835153&req=5

f2-medscimonit-22-1265: Comparison of change in hemodynamic parameters in massive (n=6) vs. submassive (n=9) pulmonary embolism (PE) groups. Dark grey bars represent change from baseline to second hour, grey bars represent change from baseline to the eighth hour, dark grey bars represent change from baseline to 24th hour, and the error bars 95% CIs for the medians. Statistical significance was determined by the the Mann-Whitney U test for comparison of continuous nonnormal data between massive PE vs. submassive PE groups. SpO2=oxygen saturation measured at room air.
Mentions: SBP, DBP, HR, shock index (SI), and SaO2 significantly improved within 24 hours after the CDT procedure (Figure 2). Notably, recovery started in the first 2 hours and was significantly evident in all hemodynamic parameters in the first 8 hours after intervention and hemodynamic improvement continued to occur over a 24-hour period. PAP improved from 59.9±12.5 mm Hg to 38.9±8.5 mm Hg (P<0.0001). Stabilization of hemodynamic parameters was achieved in the first 24 hours in 93.3% (95% CI, 70.2–98.8) of patients. The 1 unstabilized patient had massive PE; this patient died of advanced cancer during hospitalization.

Bottom Line: The primary outcomes were mortality, clinical success, and complications.Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure.In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.

ABSTRACT
BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. MATERIAL AND METHODS Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. RESULTS The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2 ± 16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04-0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2-98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. CONCLUSIONS CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

No MeSH data available.


Related in: MedlinePlus