PMID- 30378437
OWN - NLM
STAT- MEDLINE
DCOM- 20200413
LR  - 20200413
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 53
IP  - 5
DP  - 2019 May
TI  - Assessment of Anticoagulation in Patients Receiving Ultrasound-Assisted 
      Catheter-Directed Thrombolysis for Treatment of Pulmonary Embolism.
PG  - 453-457
LID - 10.1177/1060028018811155 [doi]
AB  - BACKGROUND: Ultrasound-assisted, catheter-directed thrombolysis (USAT) has 
      emerged as a popular treatment option for submassive pulmonary embolism (PE). The 
      optimal strategy for transitioning patients from full-intensity to 
      reduced-intensity heparin during the procedure has yet to be established. 
      OBJECTIVE: The goal of this study was to evaluate the anticoagulation management 
      in patients receiving catheter-directed thrombolysis with USAT. METHODS: A 
      retrospective chart review was conducted of patients who received USAT for the 
      treatment of PE. Institutional review board approval was obtained. The primary 
      objective was to determine the proportion of patients with a therapeutic 
      activated partial thromboplastin time (aPTT) prior to and during 
      tissue-plasminogen activator (tPA) infusion. Secondary outcomes included heparin 
      requirements, the rate of bleeding complications, and the appropriateness of 
      long-term venous thromboembolism management. RESULTS: A therapeutic aPTT value 
      was achieved in 32 patients (54.2%) prior to USAT and 35 patients (59.3%) during 
      tPA infusion. Heparin requirements were reduced from 15.1 +/- 4.1 to 12.8 +/- 4.2 
      U/kg/h for patients who achieved a therapeutic aPTT both prior to and during tPA 
      infusion. Bleeding occurred in 34.4% of patients and tended to be minimal (20.3%) 
      or minor (10.9%). The majority of patients were discharged on a direct oral 
      anticoagulant (63%), followed by warfarin (32%) and enoxaparin (5%). Conclusion 
      and Relevance: To our knowledge, this is the first study that has assessed 
      heparin management in the setting of USAT. The results of these data may aid in 
      empirically dose adjusting unfractionated heparin to ensure safe and effective 
      anticoagulation for patients receiving USAT.
FAU - St Pierre, Bradley P
AU  - St Pierre BP
AUID- ORCID: 0000-0001-9565-707X
AD  - 1 Ascension St John Hospital, Detroit, MI, USA.
FAU - Edwin, Stephanie B
AU  - Edwin SB
AD  - 1 Ascension St John Hospital, Detroit, MI, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20181031
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.68 (PLAT protein, human)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage
MH  - Blood Coagulation/drug effects/*physiology
MH  - Catheter Ablation/*methods
MH  - Combined Modality Therapy
MH  - Drug Administration Schedule
MH  - Female
MH  - Heparin/administration & dosage
MH  - Humans
MH  - Male
MH  - Mechanical Thrombolysis/*methods
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Pulmonary Embolism/*blood/*therapy
MH  - Retrospective Studies
MH  - Thrombolytic Therapy/methods
MH  - Time Factors
MH  - Tissue Plasminogen Activator/administration & dosage
MH  - Treatment Outcome
MH  - *Ultrasonography, Interventional
OTO - NOTNLM
OT  - anticoagulants
OT  - anticoagulation
OT  - delivery systems
OT  - heparin
OT  - thrombolytics
EDAT- 2018/11/01 06:00
MHDA- 2020/04/14 06:00
CRDT- 2018/11/01 06:00
PHST- 2018/11/01 06:00 [pubmed]
PHST- 2020/04/14 06:00 [medline]
PHST- 2018/11/01 06:00 [entrez]
AID - 10.1177/1060028018811155 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2019 May;53(5):453-457. doi: 10.1177/1060028018811155. Epub 
      2018 Oct 31.