PMID- 32703545
OWN - NLM
STAT- MEDLINE
DCOM- 20201102
LR  - 20201102
IS  - 1535-7732 (Electronic)
IS  - 1051-0443 (Linking)
VI  - 31
IP  - 8
DP  - 2020 Aug
TI  - Evaluation of Fibrinogen Levels during Catheter-Directed Thrombolysis for Acute 
      Pulmonary Embolism.
PG  - 1281-1289
LID - S1051-0443(20)30434-6 [pii]
LID - 10.1016/j.jvir.2020.04.032 [doi]
AB  - PURPOSE: To evaluate the effect of catheter-directed thrombolysis (CDT) with 
      tissue plasminogen activator (tPA) on plasma fibrinogen levels (PFLs) in the 
      setting of acute pulmonary embolism (PE) and the relationship between PFL and 
      hemorrhagic complications. MATERIALS AND METHODS: A retrospective review of CDT 
      procedures between 2009 and 2019 identified 147 CDT procedures for massive or 
      submassive PE (55.8% males; age, 56.5 +/- 14.8 years; 90.5% submassive). All 
      patients received therapeutic anticoagulation during CDT with unfractionated 
      heparin (UFH) (69.4%) or low-molecular-weight heparin (LMWH, 30.6%) infusion. CDT 
      was performed with ultrasound-accelerated thrombolysis (USAT) catheters (n = 98), 
      conventional catheter-directed thrombolysis (CCDT) catheters (n = 34), or a 
      combination of both (n = 15). RESULTS: There was a decrease (P = .007) of 15.1 +/- 
      69.4 mg/dl from the initial PFL (376.1 +/- 122.7 mg/dl) to the final PFL (361 +/- 
      118.7 mg/dl), which was measured after a mean of 24.1 +/- 11.7 hours with a mean 
      tPA dose of 28.3 +/- 14.2 mg. The fibrinogen nadir was 327.6 +/- 107.1 mg/dl measured 
      13.4 +/- 10.3 hours after initiation of thrombolysis. Of patients with hemorrhagic 
      complications (n = 6), initial, final, and nadir PFL were not significantly lower 
      (P = .053, P = .081, and P = .086, respectively) than the remainder of the 
      cohort. No significant difference was noted in initial and final PFL between the 
      LMWH and UFH groups (P = .2 and P = .1, respectively) or between the CCDT and 
      USAT groups (P = .5 and P = .9, respectively). The UFH group had a lower nadir 
      PFL than the LMWH group (P = .03). CONCLUSIONS: Despite a significant drop in PFL 
      during CDT for acute PE, this was not associated with hemorrhagic complications. 
      These findings were not affected by the choice of anticoagulant or catheter 
      delivery system.
CI  - Copyright (c) 2020 SIR. Published by Elsevier Inc. All rights reserved.
FAU - Graif, Assaf
AU  - Graif A
AD  - Department of Vascular and Interventional Radiology, Christiana Care Health 
      System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713. Electronic 
      address: Agraif@christianacare.org.
FAU - Grilli, Christopher J
AU  - Grilli CJ
AD  - Department of Vascular and Interventional Radiology, Christiana Care Health 
      System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713.
FAU - Kimbiris, George
AU  - Kimbiris G
AD  - Department of Vascular and Interventional Radiology, Christiana Care Health 
      System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713.
FAU - Paik, Helen H
AU  - Paik HH
AD  - Department of Vascular and Interventional Radiology, Christiana Care Health 
      System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713.
FAU - Leung, Daniel A
AU  - Leung DA
AD  - Department of Vascular and Interventional Radiology, Christiana Care Health 
      System, 4755 Ogletown Stanton Rd, Ste 1e20, Newark, DE, 19713.
LA  - eng
PT  - Journal Article
DEP - 20200720
PL  - United States
TA  - J Vasc Interv Radiol
JT  - Journal of vascular and interventional radiology : JVIR
JID - 9203369
RN  - 0 (Anticoagulants)
RN  - 0 (Biomarkers)
RN  - 0 (Fibrinolytic Agents)
RN  - 9001-32-5 (Fibrinogen)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
CIN - J Vasc Interv Radiol. 2020 Aug;31(8):1290-1291. PMID: 32624342
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Anticoagulants/administration & dosage
MH  - Biomarkers/blood
MH  - Female
MH  - Fibrinogen/*metabolism
MH  - Fibrinolytic Agents/*administration & dosage/adverse effects
MH  - Hemorrhage/blood/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/blood/diagnostic imaging/*drug therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Thrombolytic Therapy/adverse effects
MH  - Time Factors
MH  - Tissue Plasminogen Activator/*administration & dosage/adverse effects
MH  - Treatment Outcome
EDAT- 2020/07/25 06:00
MHDA- 2020/11/03 06:00
CRDT- 2020/07/25 06:00
PHST- 2020/01/17 00:00 [received]
PHST- 2020/04/08 00:00 [revised]
PHST- 2020/04/09 00:00 [accepted]
PHST- 2020/07/25 06:00 [pubmed]
PHST- 2020/11/03 06:00 [medline]
PHST- 2020/07/25 06:00 [entrez]
AID - S1051-0443(20)30434-6 [pii]
AID - 10.1016/j.jvir.2020.04.032 [doi]
PST - ppublish
SO  - J Vasc Interv Radiol. 2020 Aug;31(8):1281-1289. doi: 10.1016/j.jvir.2020.04.032. 
      Epub 2020 Jul 20.