Abstracts from the current literature By Ripal T. Gandhi, MD, FSIR, and Suvranu Ganguli, MD, FSIR
This column alerts SIR members to abstracts that may have an impact on their practice and how they converse with referring clinicians. If you would like to suggest abstracts you feel should be included, email us at
gandhi@baptisthealth.net or
sganguli@mgh.harvard.edu.
JACC Cardiovasc Interv. 2018 Jul 23;11(14):1401–1410. doi: 10.1016/j. jcin.2018.04.008.
Blood. 2018 Sep 20. pii: blood-2018-03-836783. doi: 10.1182/blood-2018- 03-836783. [Epub ahead of print]
Residual vein occlusion in relation to immediate compression and postthrombotic syndrome in deep vein thrombosis.
Amin EE, Bistervels IM, Meijer K, Tick LW, Middeldorp S, Mostard G, van de Poel M, Serné EH, Otten HM, Klappe EM, Joore MA, Ten Cate H, Ten Wolde M, Ten Cate-Hoek AJ.
Thus far the association between residual vein occlusion and immediate compression therapy and postthrombotic syndrome is undetermined. Therefore, we investigated whether compression therapy immediately after diagnosis of deep vein thrombosis affects the occurrence of residual vein obstruction (RVO) and whether the presence of RVO is associated with postthrombotic syndrome and recurrent venous thromboembolism. In a pre-specified sub study within the IDEAL DVT trial, 592 adult patients from 10 academic and nonacademic centers across the Netherlands, with objectively confirmed proximal deep vein thrombosis of the leg, received no compression or acute compression within 24 hours of diagnosis of deep vein thrombosis with either multilayer bandaging or compression hosiery (pressure 35mmHg). Presence of RVO and recurrent venous thromboembolism was confirmed with compression ultrasonography, incidence of postthrombotic syndrome as a Villalta score of >5 at 6 and 24 months. The average time from diagnosis until assessment of RVO was 5.3 (SD 1.9) months. A significantly lower percentage of patients who did receive compression therapy immediately after deep vein thrombosis had RVO (46.3 percent vs. 66.7 percent; OR 0.46 95 percent CI 0.27–0.80; p=0.005). Postthrombotic syndrome was less prevalent in patients without RVO (46.0 percent vs. 54.0 percent; OR 0.65 95 percent CI 0.46–0.92; p=0.013). Recurrent venous thrombosis showed no significant association with RVO. Immediate compression should therefore be offered to all patients with acute deep venous thrombosis of the leg irrespective of severity of complaints. This study was registered at clinicaltrials. gov (NCT01429714) and the Dutch Trial registry in November 2010 (NTR2597)
30 IRQ | WINTER 2019
A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: The OPTALYSE PE Trial.
Tapson VF, Sterling K, Jones N, Elder M, Tripathy U, Brower J, Maholic RL, Ross CB, Natarajan K, Fong P, Greenspon L, Tamaddon H, Piracha AR, Engelhardt T, Katopodis J, Marques V, Sharp ASP, Piazza G, Goldhaber SZ.
OBJECTIVES: The aim of this study was to determine the lowest optimal tissue plasminogen activator (tPA) dose and delivery duration using ultrasound-facilitated catheter- directed thrombolysis (USCDT) for the treatment of acute intermediate-risk (submassive) pulmonary embolism.
BACKGROUND: Previous trials of USCDT used tPA over 12–24 h at doses of 20–24 mg for acute pulmonary embolism.
METHODS: Hemodynamically stable adults with acute intermediate-risk pulmonary embolism documented by computed tomographic angiography were randomized into this prospective multicenter, parallel-group trial. Patients received treatment with 1 of 4 USCDT regimens. The tPA dose ranged from 4–12 mg per lung and infusion duration from 2–6 h. The primary efficacy endpoint was reduction in right ventricular to left ventricular diameter ratio by computed tomographic angiography. A major secondary endpoint was embolic burden by refined modified Miller score, measured on computed tomographic angiography 48 h after initiation of USCDT.
RESULTS: One hundred one patients were randomized, and improvements in right ventricular to left ventricular diameter ratio were as follows: arm 1 (4 mg/lung/2 h), 0.40 (24 percent; p = 0.0001); arm 2 (4 mg/lung/4 h), 0.35 (22.6 percent; p = 0.0001); arm 3 (6 mg/lung/6 h), 0.42 (26.3 percent; p = 0.0001); and arm 4 (12 mg/lung/6 h), 0.48 (25.5 percent; p = 0.0001). Improvement in refined modified Miller score was also seen in all groups. Four patients experienced major bleeding (4 percent). Of two intracranial hemorrhage events, one was attributed to tPA delivered by USCDT.
CONCLUSIONS: Treatment with USCDT using a shorter delivery duration and lower-dose tPA was associated with improved right ventricular function and reduced clot burden compared with baseline. The major bleeding rate was low,
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