Catheter-Directed, Low-Dose Fibrinolysis Safe, Effective for PE

Catheter-Directed, Low-Dose Fibrinolysis Safe, Effective for PE

In a recent study entitled “A prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, low Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism,” published in JACC Cardiovascular Intervention, researchers reported an improved, safe and easy fibrinolysis therapy to treat pulmonary embolism (PE).

Pulmonary embolism (PE) is a disease where the lung’s principle artery is blocked by a substance traveling through the bloodstream, such as blood clots. Patients with PE suffer from various symptoms like chest pain, cough, heart palpitations, and difficulty in breathing, and some serious cases of PE may lead to collapse or even death. A number of factors may lead to PE including genetics and factors that may alter properties of blood or its flow rate like injury, surgery, pregnancy, obesity, cancer and use of hormonal contraceptions.

From the therapeutic viewpoint, a number of methods are utilized to treat PE. Examples include administration of anticoagulants, use of inferior vena cava for patients intolerants to anticoagulants, and in some rare cases surgery may also be an option though it showed poor long term outcome. One best options to treat PE is through thrombolysis therapy, a process of breakdown of blood clots using pharmaceutical agents.

One type of thrombolysis uses additional sound waves (ultrasounds) in order to accelerate the dissolution phenomenon of the blood clot. In this respect, studies reported that patients treated using ultrasound-accelerated thrombolysis completed 12 hours earlier than patients treated by means of standard catheter-directed thrombolysis. However, a main drawback of these methods is bleeding complications.

In a recent study, researchers reported a new method based ultrasound-facilitated, catheter-directed, low-dose fibrinolysis to treat PE patients with several degrees of severity. This novel method was tested on a total of 150 PE patients. Among these, 31 suffer from acute massive and 119 with submassive PE. The tests were administrated either for 12 or 24 hours and the results illustrated several positive outcomes of this method, including reduction of pulmonary hypertension, lowering of the right ventricle dilation, significant decrease of blood clots and minimization of bleeding (hemorrhagic) in patients with acute massive and submissive PE.

In conclusion, the short term outcomes of this new proposed therapeutic method based on ultrasound-facilitated, catheter-directed, low-dose fibrinolysis are very promising. For future clinical applications, researchers concluded that long term studies are required  in order to figure out the optimal use of this therapy for acute PE. In the meantime, it will be valuable to compare the new therapy to previously utilized ones in a large number of patients in order to figure out how this method should be applied to patients with acute PE.

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