A pilot randomised trial of catheter-directed thrombolysis or standard anticoagulation for patients with intermediate-high risk acute pulmonary embolism
Jazyk angličtina Země Francie Médium electronic
Typ dokumentu časopisecké články, randomizované kontrolované studie
PubMed
35620984
DOI
10.4244/eij-d-21-01080
PII: EIJ-D-21-01080
Knihovny.cz E-zdroje
- MeSH
- akutní nemoc MeSH
- antikoagulancia terapeutické užití MeSH
- fibrinolytika terapeutické užití MeSH
- katétry MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- pilotní projekty MeSH
- plicní embolie * terapie MeSH
- tkáňový aktivátor plazminogenu * terapeutické užití MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- antikoagulancia MeSH
- fibrinolytika MeSH
- tkáňový aktivátor plazminogenu * MeSH
BACKGROUND: Intermediate-high risk acute pulmonary embolism (PE) remains associated with substantial mortality despite anticoagulation therapy. AIMS: The aim of this randomised pilot study was to compare catheter-directed thrombolysis to standard anticoagulation therapy. METHODS: Intermediate-high risk acute PE patients were admitted to a tertiary care centre (November 2019 to April 2021) and randomised in a 1:1 ratio to catheter-directed thrombolysis (CDT) or standard anticoagulation. Two catheters were used for the infusion of alteplase (1 mg/hr/catheter; total dose 20 mg) in the CDT group. The primary efficacy endpoint targeted improvement of right ventricular (RV) function, a decrease in pulmonary pressure, and a reduction of thrombus burden. RESULTS: Twenty-three patients were included (12 in the CDT group and 11 in the standard care group). The primary efficacy endpoint was achieved more frequently in the CDT group than in the standard care group (7 of 12 patients vs 1 of 11 patients, p=0.0004). An RV/left ventricular ratio reduction ≥25% (evident on computed tomography angiography) was achieved in 7 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.03). A systolic pulmonary artery pressure decrease of ≥30% or normotension at 24 hrs after randomisation was present in 10 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.001). There was no intracranial or life-threatening bleeding (type 5 or 3c bleeding, according to the Bleeding Academic Research Consortium classification). CONCLUSIONS: CDT for intermediate-high risk acute PE appears to be safe and effective. Further research is warranted to assess clinical endpoints.
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