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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These individuals have the following to disclose concerning possible financial or personal relationships with commercial entities (or their competitors) that may be referenced in this presentation: Nathaniel B. Wayne, PharmD: Nothing to disclose, George A. Davis, PharmD: Co-Investigator—PE Knockout Study (funding by BTG EKOS®), Tracy E. Macaulay, PharmD: Nothing to disclose, Craig J. Beavers, PharmD: Nothing to disclose, Adrian W. Messerli, MD: Primary Investigator—PE Knockout Study (funding by BTG EKOS®), Adam Dugan, MS: nothing to disclose, Susan S. Smyth, MD, PhD: Nothing to disclose.
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Wayne, N.B., Davis, G.A., Macaulay, T.E. et al. Reduced dose thrombolysis with ultrasound-facilitated catheter-directed administration for acute pulmonary embolism reduces length of stay. J Thromb Thrombolysis 49, 540–544 (2020). https://doi.org/10.1007/s11239-019-02009-2
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DOI: https://doi.org/10.1007/s11239-019-02009-2