Pulmonary Vascular Disease |

Retrospective Study and Outcome of Patients With Massive Pulmonary Embolism (MPE) With Intrapulmonary Artery Thrombolytic Therapy (IPTA) and Thrombectomy FREE TO VIEW

Leena Gupta, MD; Kashif Hassan, MD; Arash Padidar, MD; Thirupathy Reddy, MD
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Geisinger Medical Center, Danville, PA

Chest. 2013;144(4_MeetingAbstracts):867A. doi:10.1378/chest.1705747
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: The role of low dose IPTA in dissolving the pulmonary clot and reducing the pulmonary arterial pressure in MPE has not been thoroughly investigated in a community based hospital. Because MPE can be devastating,minimally invasive thrombolysis is the only option remaining besides open thrombectomy

METHODS: During an 8 year period from June 2005 and March 2012, 35 patients with MPE received a safe dose of Tissue plasminogen activator (TPA) plus anticoagulation with Heparin. The primary endpoint consisted of 30 day mortality, pulmonary hypertension and recurrent PE in 90 days. The secondary end point of the study comprised of duration of hospital stay, bleeding, hemodynamic improvement and prevention of chronic thrombo-embolic pulmonary hypertension. Cardiac biomarkers, Echocardiographic markers such as RV dilatation, RV free wall hypo kinesis, paradoxical septal wall motion and CT angiographic clot load on pulmonary vasculature based on the Mastora score and Miller index were correlated with the PESI (Pulmonary Embolism Severity Index). Other quantitative measurements including PA diameter and pressures, IVC diameter, Tricuspid regurgitant volume were correlated with PESI.

RESULTS: 35 patients with MPE who received TPA were between 26-88 years old. PESI score was computed and correlated with EKG, Echocardiographic markers and Mastora and Miller Index. More than 50% of patients had evidence of RV dilatation. There was a significant decrease in length of hospital and ICU stay. Mortality was less than 1%.

CONCLUSIONS: This study supports previous evidence of better outcome with MPE being treated with thrombolytic therapy and thrombectomy as well as continuous infusion of low dose TPA for 24 hours. The PESI score, Mastora Score and Miller Index is an important determinant factor for the prognosis of patients with MPE.

CLINICAL IMPLICATIONS: Thrombolytic therapy does improve survival, cause complete dissolution of the pulmonary artery thrombus as well as decreases the incidence of developing long term chronic pulmonary hypertension without increasing risk of bleeding

DISCLOSURE: The following authors have nothing to disclose: Leena Gupta, Kashif Hassan, Arash Padidar, Thirupathy Reddy

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