Pulmonary Vascular Disease |

Thrombolysis and Inferior Vena Cava Filters for Submassive Pulmonary Embolism: A Tertiary Single-Center Experience FREE TO VIEW

Shireen Mirza; Chinthaka Bulathsinghala; Bimalin Lahiri
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University of Connecticut, Farmington, CT

Chest. 2014;146(4_MeetingAbstracts):829A. doi:10.1378/chest.1991680
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Given the paucity of data regarding safety and efficacy of chemical thrombolysis for submassive pulmonary embolism (PE), we conducted a retrospective chart review of 70 patients who received recombinant tissue plasminogen activator (tPA) for submassive PE (as defined by Jaff et al., Circulation, 2011) at one tertiary level teaching hospital.

METHODS: We conducted a retrospective chart review of all patients who received tPA for submassive PE from May 2008 to September 2012 (data for 2009 missing). Most patients at our institution receive inferior vena cava (IVC) filters prior to tPA administration. We extracted data pertaining to clinical presentation, bleeding complications, pre- and post-discharge imaging and follow-up of IVC filters.

RESULTS: Overall, we had 1 in-patient mortality (cardiac arrest likely from recurrent thromoembolism) and 1 patient opted for palliative measures. We recorded a total of 41 bleeding complications with 17 related to sites of vascular access and another 6 possibly attributable to vascular access. 7 patients experienced bleeding significant enough to warrant red cell transfusion. 25 patients had post-discharge follow-up imaging within 3 months of initial presentation. 9 of 13 follow-up VQ scans and 12 of 12 CT angiograms demonstrated complete resolution of perfusion defects. 54 patients had IVC filters placed and of these, 34 patients had follow-up(s) with radiology within 6 months. 13 filters were successfully removed and 21 were not removed due to various reasons including non-resolution of clot, inability to anticoagulate or difficult device retrieval. 20 patients were lost to follow-up.

CONCLUSIONS: In our patient cohort, thrombolysis with tPA for submassive PE was associated with in-patient mortality rate of 1.42%. 10% of patients experienced bleeding significant enough to require transfusion. Clinically apparent bleeding is frequently related to sites of vascular access. At 3 months, 84% of patients had complete resolution of significant clot burden by imaging. 37% patients were deemed ‘lost to follow-up’ for IVC filter retrieval and only 38% of filters were retrieved at follow-up.

CLINICAL IMPLICATIONS: Efforts to reduce bleeding related to sites of vascular access is a readily identifiable target to reduce morbidity and mortality related to thrombolysis. Increasing patient and physician awareness and implementing pre-discharge protocols to ensure follow-up for IVC filters may be instrumental to reducing loss to follow-up and ensuing morbidity from retained IVC filters.

DISCLOSURE: The following authors have nothing to disclose: Shireen Mirza, Chinthaka Bulathsinghala, Bimalin Lahiri

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