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Reduced dose thrombolysis with ultrasound-facilitated catheter-directed administration for acute pulmonary embolism reduces length of stay.
Wayne, Nathaniel B; Davis, George A; Macaulay, Tracy E; Beavers, Craig J; Messerli, Adrian W; Dugan, Adam; Smyth, Susan S.
Afiliação
  • Wayne NB; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA. nwayne@augusta.edu.
  • Davis GA; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
  • Macaulay TE; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
  • Beavers CJ; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
  • Messerli AW; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
  • Dugan A; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
  • Smyth SS; University of Kentucky HealthCare, Gill Heart and Vascular Institute, 800 Rose St, Lexington, KY, 40536, USA.
J Thromb Thrombolysis ; 49(4): 540-544, 2020 May.
Article em En | MEDLINE | ID: mdl-31797241
ABSTRACT
The optimal dose and duration of tissue plasminogen activator (tPA) administered with ultrasound-facilitated catheter-directed thrombolysis (USCDT) to patients with acute PE remains to be determined. Our institution recently adopted a shorter duration (4 h) of USCDT and lower dosing strategy (tPA 1 mg/h) based on data from the OPTALYSE PE Trial. The purpose was to evaluate the implementation at our institution of shorter duration (4 h) of USCDT and lower dosing strategy (tPA 1 mg/h) as outlined by OPTALYSE PE Trial. This was a retrospective, single-center, observational study included patients from 01/01/2017 to 12/31/2018 in a large, academic medical center. Group 1 represented patients who underwent USCDT prior to 01/18/18. Group 2 represented patients who underwent USCDT after 01/18/18 and received 4 h of USCDT and tPA 1 mg/h/catheter. The primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes were the proportion of patients experiencing a composite of major adverse events (death, recurrent PE, major bleeding, or stroke), change in right ventricle size/function and pulmonary artery pressures, need for mechanical respiratory or hemodynamic support, hospital LOS and drug cost. A total of 31 patients were included in the study twenty patients in Group 1 and eleven patients in Group 2. Median ICU LOS was 3.5 days in Group 1 and 1 day in Group 2. Group 2 had reduced MACE, requirement for mechanical respiratory or hemodynamic support, hospital LOS, drug costs and adverse events. Implementation of a shorter duration of USCDT and lower dosing strategy for tPA in patients with acute PE may be one strategy to reduce the total ICU LOS and costs associated with care.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Embolia Pulmonar / Terapia Trombolítica / Ativador de Plasminogênio Tecidual / Fibrinolíticos / Tempo de Internação Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thromb Thrombolysis Assunto da revista: ANGIOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Embolia Pulmonar / Terapia Trombolítica / Ativador de Plasminogênio Tecidual / Fibrinolíticos / Tempo de Internação Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thromb Thrombolysis Assunto da revista: ANGIOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos