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As we begin to see more patients admitted to hospitals with massive and submassive pulmonary embolisms (PE), medical specialists are reporting that other interventional approaches in dissolving a PE may be better. Up to now, the standard therapy for a PE has been anticoagulation with observation or opening the chest.
NEW YORK, NY (PRWEB) November 19, 2012
As we begin to see more patients admitted to hospitals with massive and submassive pulmonary embolisms (PE), medical specialists are reporting that other interventional approaches in dissolving a PE may be better. "Up to now, the standard therapy for a PE has been anticoagulation with observation or opening the chest," said Tod C. Engelhardt, MD, chairman of cardiovascular and thoracic surgery at East Jefferson General Hospital (Metairie, Louisiana) to an audience of 4,000 vascular surgeons and vascular specialists at the 39th Annual VEITHsymposium in New York (November 14-18, 2012).
Once such interventional approach is catheter-directed ultrasound-accelerated thrombolysis (USAT) that rapidly reduces right ventricular dilatation and pulmonary clot burden among patients with both massive and submassive PE, according to Engelhardt.
“Optimal patient outcomes are achievable with a low tPA dose, thus minimizing the risk of bleeding complications,” said Dr. Engelhardt at the 39th annual VEITHsymposium in New York. “It’s time that hospitals across the globe look to these devices as an alternative to open surgery,” Engelhardt noted.
Engelhardt provided a significant update reporting 42 patients (with acute PE treated by USAT which reduced the RV/LV ratio from 1.4±0.4 to 1.0±0.2 (p<0.001), as measured by CT performed at 39±23 hours. RV dysfunction was characterized by the right-to-left ventricular dimension (RV/LV) ratio. Thrombus burden, measured with the modified Miller Score, was reduced from 18±5 to 10±5 (p<0.001) at follow-up CT.
In addition, the mean recombinant tPA (Alteplase) dose of 31.0±16.6 mg was infused along with ultrasound over 19.0±6.8 hours. Patients who were treated early in the series (n=13), received an average total dose of approximately 45 mg tPA, while those later in the series (n=29) received an average total dose of approximately 20 mg tPA (p=0.38). However, the earlier patients did not have a greater reduction in RV/LV ratio or Miller Score than later patients.
Engelhardt emphasized, “Patients with PA are routinely treated using USAT (EkoSonic® Endovascular System) with tPA at East Jefferson General Hospital.” The retrospective analysis included 42 patients (mean age 58 years) – seven had massive PEs and 35 had submassive PEs. Thirty-seven patients (88%) presented with bilateral PE.
In terms of safety, all patients were discharged alive. There were no systemic bleeding complications. However, there were four access site bleeding complications requiring transfusion and one suspected recurrent massive PE event. These complications were reported in the early higher-dose tPA group; no bleeds reported in the low dose group.
The median length of stay was 1 day in the ICU and 7 days in the hospital.
Our ongoing study continues to when treated with USAT.
About VEITHsymposium: Now in its fourth decade, VEITHsymposium provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features over 750 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques. To register to attend the VEITHsymposium, please visit http://www.VEITHpress.org or contact Pauline T. Mayer at 631.979.3780.
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