Combined catheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism
Source: Internal Medicine Journal, Volume 41, Number 9, 1 September 2011 , pp. 687-691(5)
Aims: The aim of this study is to evaluate the effectiveness and safety of combined catheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism (PE).
Methods: Forty‐six patients (19 men and 27 women, average age 52.3 ± 13.4 years) with acute PE and right ventricular dysfunction were treated by mechanical thrombus fragmentation with a percutaneous transluminal coronary angioplasty guide catheter. Urokinase was injected into the culprit pulmonary artery after catheter thrombus fragmentation in all patients.
Result: Clinical success was achieved in all patients. After the treatment, the average pulmonary artery pressure was decreased from 57.2 ± 6.2 to 36.3 ± 4.1 mmHg (P < 0.01). The oxygen saturation rate was raised from 81.4 ± 4.3% to 97.0 ± 2.0% (P < 0.01), and the right ventricular function was improved. There was no in‐hospital mortality and there were no major complications, such as haemorrhage. Patients were treated with warfarin for 6 months with no signs of PE recurrence during the follow up.
Conclusion: In PE patients with right ventricular dysfunction and unstable haemodynamics, combined catheter thrombus fragmentation and thrombolysis appears to be a useful therapeutic strategy. In PE patients with right ventricular dysfunction and stable haemodynamics, randomized trials are still required to show that combination of catheter‐directed thrombus fragmentation and thrombolysis is superior to standard anticoagulation.
Document Type: Research Article
Affiliations: 1: Department of Cardiology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng City, Shandong Province, China, and 2: School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
Publication date: September 1, 2011