Download This PaperFixed-Dose Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Pulmonary Embolism Associated with COVID-19
19 Pages Posted: 1 Mar 2022
Abstract
Background: Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown.
Methods and results: The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10-20 mg/15 hours). Of these, 9 patients tested positive for COVID-19 and were age-sex matched to 27 patients without COVID-19. The USAT protocol included anti-Xa-activity-adjusted unfractionated heparin (target 0.3-0.7 U/L). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67±14 years. Mean±standard deviation mPAP decreased from 32.3±8.3 to 22.4±7.0 mmHg among COVID-19 patients and from 35.4±9.7 to 24.6±7.0 mmHg among unexposed, with no difference in the relative improvement between groups (p=0.84). Within 12 hours of USAT start, the median NEWS decreased from 6(Q1-Q3:4-8) to 3 (Q1-Q3:2-4) points among COVID-19 patients and from 4(Q1-Q3:2-6) to 2(Q1-Q3:2-3) points among unexposed (p=0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred.
Conclusions: Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19.
Note:
Funding: This work was supported by Boston Scientific Corporation with an unrestricted grant.
Declaration of Interests: Stefano Barco has received congress and travel payments from Daiichi-Sankyo, Boston Scientific, and Bayer HealthCare; institutional grants from Sanofi, Boston Scientific, Bard, and Bayer HealthCare; and personal fees and honoraria from Bayer HealthCare, LeoPharma, Boston Scientific, and Daiichi-Sankyo. Nils Kucher reports grants from Swiss National Science Foundation, Concept Medical, Bard, and Bayer; and personal fees from Bayer, Bard, Medtronic, Boston Scientific, BTG, and Pfizer. Davide Voci, Stephanie Zbinden and Evy Micieli have nothing to disclose.
Ethics Approval Statement: The local Ethical Commission approved the study protocol on 25th March 2021 (BASEC ID 2021-00579). The study complies with the Declaration of Helsinki. The study was approved by the local ethical commission: “Kantonale Ethikkommission Zürich” with the following ID number: (2021-00579)
Keywords: pulmonary embolism, thrombolysis, venous thromboembolism, COVID-19, SARS-COV2
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