Ultrasound-Assisted Catheter-Directed Thrombolysis: A Safe Alternative to Anticoagulation for PE

Ultrasound-assisted catheter-directed thrombolysis (USAT) is a safe and effective emerging therapy for patients with submassive pulmonary embolism, according to research to be presented at the American College of Cardiology 2019 Scientific Sessions, held March 17-19 in New Orleans, Louisiana.

Researchers from the University of North Carolina School of Medicine in Chapel Hill, North Carolina, conducted a prospective study of 61 patients presenting with submassive pulmonary embolism (PE) who were treated at a tertiary care center.

Two study cohorts were created; the first (n=27; mean age, 56.9; 51.9% male) received between 8 mg and 24 mg of tissue plasminogen activator (tPA) infused via USAT catheter, while the second (n=34; mean age, 62.6; 50% male) received therapeutic anticoagulation.

Researchers found that undergoing treatment for cancer was “the only significant clinical predictor of selection for USAT” (4% of USAT vs 29% of therapeutic anticoagulation).

Between both groups, there were no significant differences in length of hospital stay (6.11 vs 7.15 days), 6-month readmission rate (15.4% vs 31.6%), or discharge with supplemental oxygen (27% vs 18%).

Tree patients in the therapeutic anticoagulation group died within 6 months, and 2 experienced bleeds with a Bleeding Academic Research Consortium score 2.5. In the USAT group, RV dilation and RV dysfunction “significantly improved” on echocardiography.

“The improvements in RV function and PA pressure after USAT are consistent with published findings,” the researchers concluded. “Further study is needed to understand why patients with cancer are less likely to receive USAT.”

Reference

Haywood H, Pauley E, Rossi J. Ultrasound-assisted catheter-directed thrombolysis: the experience of a tertiary care medical center. Presented at: American College of Cardiology 2019 Scientific Sessions; March 17-19, 2019; New Orleans, Louisiana. Abstract 483.