Catheter Directed Thrombolysis for Intermediate Risk Pulmonary Embolism.
Ann Am Thorac Soc. 2017 Oct 26;:
Authors: Furfaro D, Stephens RS, Streiff MB, Brower R
Intermediate risk pulmonary embolism is common and carries a risk of progression to hemodynamic collapse and death. Catheter directed thrombolysis is an increasingly utilized treatment option, based largely on the assumptions that it is more efficacious than anticoagulation alone, and safer than systemic thrombolysis. In this review, we critically analyze the published data regarding catheter directed thrombolysis for the treatment of intermediate risk pulmonary embolism. Catheter directed thrombolysis reduces right heart strain and lowers pulmonary artery pressures more quickly than anticoagulation alone. The mortality for patients with intermediate risk pulmonary embolism treated with catheter directed thrombolysis is low, between 0% and 4%. However, similarly low mortality is seen with anticoagulation alone. Catheter directed thrombolysis is safer than systemic thrombolysis, and procedural complications are uncommon. Bleeding appears to be slightly higher than with anticoagulation alone. Randomized, controlled trials are needed to compare the efficacy and safety of catheter directed thrombolysis versus anticoagulation for intermediate risk pulmonary embolism. There is no evidence that catheter directed thrombolysis decreases the incidence of chronic thromboembolic pulmonary hypertension. There is no evidence from clinical studies that ultrasound assisted thrombolysis is more effective or safer than standard catheter directed thrombolysis.
PMID: 29073366 [PubMed - as supplied by publisher]